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WHAT ASYLUMS WERE, ARE, AND OUGHT TO BE: 

BEING THE SUBSTANCE OF 

FIVE LECTURES 

DELIVERED BEFORE 

THE MANAGERS 

OF THI. 

-MONTROSE ROYAL LUNATIC ASYLUM. 

/ " 
W. A. F. BROWNE, Surge.. 

MEDICAL SUPERINTENDENT OF THE MONTROSE ASYLUM, FORMERLY 
PRESIDENT OF THE ROYAL MEDICAL SOCIETY, EDINBURGH, &fe 

< . 

EDINBURGH : 
ADAM AND CHARLES BLACK, 

AND LONGMAN, REKS, ORME, BROWN, GREEN, AND LONGMAN, 
LONDON. 



MDCCCXXXVII. 
.11 



a 












EDINBURGH : PRINTED BY BALFOUR AND JACK, NIDDRY STREET. 



THIS WORK 

IS DEDICATED, 3 ^ 

WITH SINCERE RESPECT AND GRATITUDE, 
TO 

ANDREW COMBE, M.D., 

PHYSICIAN TO THEIR MAJESTIES THE KING AND QUEEN OF THE BELGIANS ; 

AUTHOR OF " OBSERVATIONS ON MENTAL DERANGEMENT j" 

" PRINCIPLES OF PHYSIOLOGY, AS APPLIED TO HEALTH 

AND EDUCATION," &.C. 

AS AN ACKNOWLEDGMENT 

OF THE BENEFITS CONFERRED ON SOCIETY, 

BY 

HIS EXPOSITION OF THE APPLICATION OF PHRENOLOGY IN THE 

TREATMENT OF INSANITY AND NERVOUS DISEASE9 ; 

AND 

OF PRIVATE BENEFITS CONFERRED, 

AS 

THE MOST ENLIGHTENED PRECEPTOR, THE MOST DISINTERESTED 

ADVISER, AND THE KINDEST FRIEND, 

OF THE 

AUTHOR. 



TO THE MANAGERS OF THE MONTROSE ROYAL 
LUNATIC ASYLUM. 



My Lord and Gentlemen, 

To the many obligations -which you have 
already conferred upon me, is now to be added the permission 
to publish the following pages under your sanction and 
patronage. In offering them for your acceptance, as a very 
imperfect proof of the importance which I attach to the office 
to which you appointed me, and as an equally imperfect 
acknowledgment of my gratitude for the uniform kindness 
and support which I have received from you, I have to express 
the deep respect and admiration which I entertain for tin- 
anxiety which you have ever manifested, and the exertions 
which you have made, and are now making, to promote the 
happiness and cure of those lunatics whose interests are more 
immediately confided to your care. 

I have the honour to be, 

My Lord and Gentlemen, 

Very much your obedient servant.. 

W. A. F. BROWNE. 



Montrose, May 1837- 



PREFACE. 



My object in publishing the following Lectures, was to draw 
the attention of the public, and especially of those who are by 
profession engaged in, or who by philanthropy are prompted 
to, works of mercy, to the consideration of what has been 
done, and what remains to be done, for the relief of the 
most unfortunate of our fellow-men : of those who may be 
almost literally said to r * sit in darkness, and in the shadow 
of death : being fast bound in misery and iron." My in- 
ducements to publish were, first, the countenance and en- 
couragement which I received from the Directors of the 
establishment under my charge, to whom my observations 
were in the first instance addressed ; and, secondly, the 
hope that a plain and clear statement of facts by a practical 
man might reach and influence those who administer either 
by their opinion or by their power to the necessities of the 
" poor in spirit." If my appeal should, even to a limited 
extent, excite the sympathy of those who are blessed with a 
sane, a benevolent, and a cultivated mind, and engage them 
as cordially in the attempt to ameliorate the condition of the 
lunatic, as similar, and even less clamant appeals have done 
in behalf of the slave, the oppressed, the destitute; little 
difficulty will be found in removing the evils, and in carrying 
into effect the improvements which I have suggested, and an 
amount of happiness will be secured to the objects of my so- 
licitude which has hitherto been denied to them, but to which 



Vlll PREFACE. 

they are as clearly entitled as the slave to freedom, or the 
poor to pity and relief. 

I have no claim to originality, either in the design or the 
execution of the present production. A large portion of the 
volume refers to the past, and is necessarily occupied with 
historical details : that portion which refers to the future I 
have as scrupulously as was practicable collected and collated 
from the writings and opinions of others : and when present- 
ing a synoptical view of the different forms under which 
mental disease may appear, I was indebted rather to the 
science upon the principles of which that arrangement was 
founded, than to any peculiar views or philosophical analysis 
of my own. To those who are acquainted with the doctrines 
of Phrenology, the extent of my obligations in this particular 
case, and throughout the work, will be readily recognized ; 
and to those who are still ignorant of these doctrines, I have 
to offer the assurance that Insanity can neither be understood, 
nor described, nor treated by the aid of any other philosophy. 
I have long entertained this opinion : I have for many years 
put it to the test of experiment, and I now wish to record it 
as my deliberate conviction. While, however, I have con- 
stantly availed myself of the principles, I have avoided the 
phraseology of the science, first, because my original auditors 
were not, and my readers may not be phrenologists ; and, se- 
condly, and chiefly, because my object was not to advocate or 
promote particular truths, but to employ and apply these in 
the elucidation of the object in view> and thereby to place in 
as clear, and conclusive, and acceptable a manner as possible, 
the noble cause which I have undertaken. 



3 



CONTENTS. 



LECTURE I. 

WHAT IS INSANITY? 

Page 
Erroneous views on the Subject — Propensities, Sentiments, Re- 
flective and Perceptive powers — The dependence of these on 
Organization. — Derangement a disease of the Brain — The 
changes which occur in the structure of the Brain — Evidence 
that such changes take place — Extent of diseased action which 
constitutes Insanity — Description preferable to definition of the 
disease where the regulation of the internal economy of Asylums 
is concerned — Nosological classification of the varieties of the 
Disease — Arrangements of Arnold, Heinroth, and Author — 
Idiocy — Its four gradations — Fatuity, partial, complete — Mo- 
nomania, erotic, homicidal and destructive, proud, vain, timid, 
suspicious, religious and superstitious, desponding and suicidal, 
; maginative, avaricious, benevolent, and affectionate — Incapabi- 
lity of perceiving the relations of ideas — Incapability of perceiv- 
ing the relations of external objects — Incapability of perceiving 
the qualities of external objects — Mania, with and without in- 
creased activity — Conclusion .... I 

LECTURE II. 

WHAT ARE THE STATISTICS OF INSANITY? 

The numbers and distribution of Lunatics in Britain — Is insanity 
increased by civilization — Does it increase in a greater ratio than 
the population — Does it attack men of particular professions, or 
of particular ranks — Does it prevail chiefly under free, or under 



J 



CONTENTS. 

Page, 
despotic forms of Government — What period of life does it prin- 
cipally attack — Does marriage diminish the liability to the dis- 
ease — Are Males or Females most exposed — What is the pro- 
portion of cures — Rate of Mortality — Does Insanity prolong or 
shorten life — Influence of season on Mortality — Diseases affect- 
ing Lunatics — Proportion of Furious, Paralytic and Epileptic, 
Fatuous and Idiotic, Dirty, Noisy and Suicidal Madmen — Lucid 
Intervals — Relapses — Complete isolation — Early confinement — 
Employment as a means of cure — Proportion of Lunatics that 
may be employed — Does it promote the cure? — The kind of 
occupation — Is it safe ? . . . . 51 



LECTURE III. 

WHAT ASYLUMS WERE. 

Character of System pursued previous to 1815 — St. Vincent de 
Paul — Insane consigned to Monks — Lunatics set at large to beg 
— Lunatics in Gaols, in Cages, in Caves, in Dungeons — Asso- 
ciating of Lunatics with criminals — Modes of quieting Lunatics 
— "Muffing" — Modes of feeding Lunatics — * Forcing" — Death 
from this process — Lunatics in Hospitals — Four or five sleep 
in one bed — Confined in Venereal Wards — Lunatics in Work- 
houses — Want of Medical attendance, classification, comfort, 
and cleanliness in these establishments — Sale of Idiot children — 
Madhouses at Venice, Nantes — Confinement of sane indivi- 
duals — Carelessness of Medical men in granting certificates — 
Unusual modes of coercing the Insane — Coercion required for 
the poor, but not for the rich — ^Coercion resorted to as economi- 
cal — Lunatics exhibited for a sum of money ; excited and induced 
to gorge themselves with food, or filth, for the amusement of 
visitors — Gangrene of extremities from cold — Insufficient supply 
of food, of clothing — No medical or moral treatment — Superin- 
tendence confided to ignorant and dissolute keepers — Terror as 
a remedy — Cruelty and immorality of servants — No separation 
of sexes — Unhealthy cells — Concealment of mortality — Deaths 
from fury of keepers and patients — Records burned to frustrate 
inquiry, &c— A visit to Asylums as they were* . 98 



CONTENTS. XI 

LECTURE IV. 

WHAT ASYLU3JS ARE. 

Page. 
The old system not altogether exploded — Commencement of the 

present system — Liberation of Lunatics at Bicetre by Pinel — 
The adoption of enlightened principles partial, but a desire for 
improvement prevalent — First recognition of humanity and occu- 
pation as means of treatment in remote times, in Egypt and 
Belgium — Present mode of treatment characterized by want of 
classification, want of employment, want of bodily exercise — 
Asylums insufficiently heated — Error of supposing Lunatics 
impregnable to cold — Inattention to personal comfort of Luna- 
tics — Corporal punishment professedly abandoned ; but cruelty 
in various forms still committed — Patients confined to bed to 
accommodate servants — Inadequate number of keepers — Coer- 
cion as a means of cure, of protection — Character and qualifica- 
tions of attendants on Insane — Evils of indiscriminate associa- 
tion of insane — No wards for convalescents exists — Grounds 
for separating Lunatics — Erroneous views of moral treatment — 
Night visits — Mental anxiety and disturbance produced by the 
oppressive, harsh, indelicate or derisive conduct of keepers- 
Substitution of convalescent patients for keepers — Important 
duties imposed on this class of servants — Difficulty of procuring 
well-educated persons to undertake such responsibility — Exclu- 
sion, desertion of friends of Lunatics — Asylums ill-adapted 
for reception of rich — Luxurious diet — Indiscriminate diet — 
Solitary meals — Prejudices of public present obstacles to im- 
provement — Examples — How are these to be removed ? . 134 



LECTURE V. 

WHAT ASYLUMS OUGHT TO BE. 

A perfect Asylum a Utopia — Belief of the inadequate provisions 
for the cure of the insane in asylums, general — Character of the 
physician — Benevolence, conscientiousness, courage — Intellec- 



J 



Xil CONTENTS. 

Page 
ttral qualifications— Site of an asylum — It may contribute to the 
cure of the inmates— Construction of the building — Size of 
apartments — Night-classification — Houses of one story — Dor- 
mitories — Night-keepers — Portion of asylum fire-proof — Pad- 
ding of walls — Heating the apartments by the circulation of 
hot water— Clothing — Airing-grounds — Shrubberies — Gardens 
—Farm-employment of patients— Payment for labour — Classi- 
fication—Religious worship and instruction — Fallacies in moral 
treatment — Dancing— Voisin's and Esquirol's establishments — 
Asylum at Sonnenstein — Library — Asylums at Naples, at Hart- 
^ ford, United States— Visit to an asylum as it ought to be. 176 



LECTURE I. 



WHAT IS INSANITY ? 



Erroneous views on the Subject — Propensities, Sentiments, Reflec- 
tive and Perceptive powers — The dependence of these on Organi- 
zation — Derangement a disease of the Brain — The changes which 
occur in the Structure of the Brain — Evidence that such changes 
take place — Extent of diseased action which constitutes Insanity — 
Description preferable to definition of the disease where the regu- 
lation of the internal economy of Asylums is concerned — Nosologi- 
cal classification of the varieties of the Disease — Arrangements of 
Arnold, Heinroth, and Author — Idiocy — Its four gradations — Fa- 
tuity, partial, complete — Monomania, erotic, homicidal and de- 
structive, proud, vain, timid, suspicious, religious and eupersti- 
tious, desponding and suicidal, imaginative, avaricious, benevolent, 
and affectionate — Incapability of perceiving the relations of ideas — 
Incapability of perceiving the relations of external objects — Incapa- 
bility of perceiving the qualities of external objects — Mania, with 
and without increased activity — Conclusion. 

Gentlemen, — The pages which I am about to submit 
to you, and subsequently to the public, possess one quality 
which many regard as a merit, but which I am inclined to 
think is a misfortune. It is that of originality. No attempt, 
so far as I know, has yet been made to condense, in a plain, 
practical, and still popular form, the results of observation 
in the treatment of insanity, for the specific and avowed 
purpose of demanding from the public an amelioration of 
the condition of the insane. The motives which have ac- 
tuated me in bestowing a very careful, and, I humbly trust, 
a candid examination on the subject, have been a profound 
sympathy for the misfortunes of the insane, and a keen feel- 

B 



z WHAT IS INSANITY. 

ing of indignation that these misfortunes should often be 
multiplied through the apathy, or ignorance, or cruelty of 
those who have it in their power to become benefactors, in 
the noblest sense of the term, and in the noblest cause which 
can arouse virtuous ambition. Should this attempt to en- 
list in that eause the feelings of justice and mercy in every 
bosom, in any degree succeed, as by the blessing of a just 
and merciful God I trust it may, and should the cry for im- 
provement in public Asylums be raised where hitherto the 
silence of indifference has reigned, the only reward which I 
covet will have been obtained. 

What is insanity ? The question may be put and answer- 
ed in two senses ; either philosophically or practically ; ei- 
ther as directed to ascertain the actual condition of the 
mind which constitutes disease, or to determine that amount 
of diseased action which compromises the safety of the suffer- 
er, -and justifies legal interference. Our chief concern is 
with the aspect which the disease presents, after the law has 
interfered. In order to arrive at just conclusions on such a 
subject, it is incumbent to understand something of the na- 
ture, the powers, and the laws of the mind while in posses- 
sion of health and vigour. This is generally overlooked in 
the investigation, and the verdict of the public and of a jury 
is as recklessly and ignorantly pronounced respecting men- 
tal strength, as if the points at issue were the discovery of 
the perpetual motion or the utility of a comet. It is not to 
be expected that either of these tribunals should be com- 
posed of metaphysicians; but it is highly desirable that 
every man, qualified by his station in society to judge or 
legislate in such matters, should be competent by education 
to found and form his judgments on a knowledge of what 
consciousness and observation shew to be the laws of our 
spiritual nature. So vague are the ideas generally enter- 
tained, or, rather, so destitute is the great majority of even 
educated men of any ideas or definite opinions as to mental 



WHAT IS INSANITY. & 

philosophy, that very recently the capability of repeating 
the Multiplication Table was gravely propounded in an 
English court of law as a test of sanity. This looks like 
satire on the reputed money-making propensities of this na- 
tion, but the proposal had no such origin. And to prove 
how momentous the interests are which hinge upon a clear 
comprehension of what insanity is, it may be mentioned 
that in the very case where this arithmetical crux was sug- 
gested, immense property and the reputation and affections 
of many individuals were at stake. 

So far as our present purpose is concerned it may be suffi- 
cient to know, that the mind consists of four classes of 
powers. The first of these are mere instincts or impulses, 
manifested by us in common with the lower animals, capa- 
ble of being directed by reason, or the moral feeling, to 
great and noble ends, but in themselves prompting merely 
to love, to combat, to acquire, and so forth. The second 
class comprehends the sentiments where there is a vivid 
emotion superadded to a propensity to act ; among these are 
feelings of pride, vanity, veneration, hope, &c. The purely 
intellectual powers constitute the third class. By them we 
recognise the relations of ideas, of the impressions of the 
mind itself; we are enabled to trace effects to their causes, 
to ascertain the difference or agreement of propositions, and 
to conduct what is commonly called a process of reasoning. 
In the fourth class are the observing powers, those by which 
we perceive the qualities and relations of external objects. 

Now it appears that all these feelings and faculties are 
gradually developed and that they gradually decline ; that 
they are weak in infancy, strong at maturity, and again 
weak in old age ; that their evolution and decay correspond 
with the changes in organization. Farther, it has been as- 
certained, that the condition and intensity of these powers 
is influenced by^the state of the body, by external and in- 
ternal stimuli; that in certain affections of the nervous sys- 



^ WHAT IS INSANITY. 

tern, as intoxication, their energy is impaired ; and that in 
certain other affections, as phrenitis and ramollissement, 
their operation is altogether destroyed. Lastly it is proved, 
that the integrity and health of these powers depend upon 
the structure of the brain and its coverings ; that if this 
organ be prevented from attaining a certain size, no mental 
manifestations appear; that if by accident or disease, the 
nervous mass should be directly or indirectly injured, these 
manifestations are diminished in number, impaired in 
strength, or annihilated. In what manner this connexion 
between mind and matter is effected, is not here inquired 
into. The link will, perhaps, ever escape human research. 
Enough has been disclosed to teach us the importance of 
recognising the connexion, and of making it the foundation 
of all inquiries into the nature of mental alienation, and of 
all attempts to improve the condition of the insane. From 
lha admission of this principle, derangement is no longer 
considered a disease of the understanding, but of the 
centre of the nervous system, upon the unimpaired con- 
dition of which the exercise of the understanding de- 
pends. The brain is at fault and not the mind. The 
brain is oppressed by blood ; it is irritated ; it is softened ; 
and the ideas are confused, the feelings exalted, because 
that part of the system with which their healthy manifesta- 
tion has been associated in this world, has undergone an al- 
teration. But let this oppression be relieved, this irritation be 
removed, and the mind rises in its native strength, clear and 
calm, uninjured, immutable, immortal. In all cases where 
disorder of the mind is detectable, from the faintest pecu- 
liarity to the widest deviation from health, it must and can 
only be traced directly or indirectly to. the brain. The 
change may exist in its own structure, or in distant organs 
which influence its condition, but that which renders it im- 
possible that the mental operation should be continued with 
regularity, or equanimity, is to be referred to the brain. For 



WHAT IS INSANITY. O 

example, if a blow is received on the forehead, the skull is de- 
pressed, the brain is lacerated or contused, and the individual 
passes at once from the possession of a sound and powerful rea- 
son, from a clear and correct perception of the position which 
he occupies, the plans he has formed, and of the knowledge 
and energies he can put forth, into a dark fatuity, a bewil- 
derment of thought, an ignorance of all he has done, can do, 
or is required to do. Here the two facts of cerebral mutila- 
tion, and of deprivation of intellect stand so distinctly in the 
relation of cause and effect, that all men are accustomed to 
regard them, and are warranted in regarding them in this 
light. Again, if the dissolute and reckless debauchee per- 
severe for long years in the practice of gratifying his palate, 
and destroying his digestive powers, and keeping his ner- 
vous and circulating systems in a state of excitement, alike 
inimical to virtue and to health, the first indication of the in- 
terruption to his enjoyments, and of the incursion of disease 
may be in the stomach. Uneasy sensations, pain, disorga- 
nization will attract his attention ; his reason will in vain 
attempt steadily to contemplate his situation, his fears are 
up in arms, the whole mind totters and ultimately falls. 
After a few years of raving madness, or helpless idiocy, he 
dies. On dissection, the stomach may exhibit traces of 
deep-seated, long-continued morbid action, the obvious con- 
sequences of frequent exposure to stimulants. But will this 
be the only lesion discoverable ? Can such changes, which 
are found to follow other causes without disturbing the 
functions of the brain, in this particular case produce insa- 
nity ? — Experience proves the reverse of this. In, or 
around the brain will be detected some obvious alteration 
of structure, with the existence of which health was incom- 
patible. The incessant determination of an accelerated or 
vitiated current of blood to the head, or the condition of 
the nervous system consequent on repeated intoxication, 
accounts for the production of this alteration. Occasion- 



6 WHAT IS INSANITY, 

ally, cases occur where the lesions are very slight, have 
been overlooked, or, according to some authors, have not 
existed. The disease, in the latter case, is called functional, 
or is supposed to depend upon some change in the propor- 
tion or qualities of the elements of which the brain is com- 
posed, not appreciable by our senses, nor detectable by che- 
mical agents. Neither of these explanations is satisfactory. 
The prevailing opinion at present is, that no cases do occur 
where no pathological condition can be observed : that those 
recorded owe this feature to the negligence or ignorance of 
the narrator, and that, should such cases really exist, the 
brain must be affected similarly to the rest of the body in 
fever, where the alterations are evanescent, disappearing on 
the extinction of life. But what does history contribute to 
the settlement of the question. Greding noticed thickening 
of the skull in one hundred and sixty-seven out of two hun- 
dred and sixteen cases, besides other organic disease. It 
ought to be observed, that Greding was in search of a par- 
ticular morbid appearance. Davidson, of Lancaster Asy- 
lum, in the examination of two hundred cases, scarcely ever 
met a single instance in which evident traces of diseased 
action were not found. Dr. Wright, Bethlem, dissected one 
hundred cases, and saw disorganization of the brain, &c. in 
all. Dr. Haslam, St. Lukes, says, insanity is always con- 
nected with organic changes. Georget, Falret, Voisin, Cox, 
Crighton, Crowther, Burrows, &c. entertain the same opi- 
nion. 

Insanity, then, is inordinate or irregular, or impaired ac- 
tion of the mind, of the instincts, sentiments, intellectual, or 
perceptive powers, depending upon and produced by an or- 
ganic change in the brain ; the extent of the disease corres- 
ponding to the extent of the destruction or injury of the 
nervous structure.* It is here particularly worthy of notice/ 

* " A great error has arisen," says Newnham, " and has been per- 
petuated even to the present day, in considering cerebral disorder as 



WHAT IS INSANITY. 

that being strictly a bodily disease, the nature, intensity 
and aggravations of insanity must be regulated, in a great 
measure, by the relation of the brain to the other organs of 
the body, and the relation of both of these to external 
agents : and that if such a dependence exists, an equally 
intimate connexion must be concluded to obtain between 
the means of cure and the state of these organs and external 
agents. 

But, in determining what treatment ought to be adopted 
in cases of lunacy, how is the degree of diseased action to 
be estimated, or rather, what departure from the healthy 
standard is to be recognised and treated as disease ? There 
appears to be a necessity for some estimate of this kind, 
however vague, and upon whatever principles founded, in 
every case where confinement is advised, or resorted to. 
But, first, is there a healthy standard, or if there be, how is 
it to be ascertained ? 

In the well known trial relating to the lunacy of Miss 
Bagster in 1832, Dr. Haslam gave two rather startling an- 
swers when urged by Mr., now Sir F. Pollock. He is re- 
ported to have said, " I never saw any human being who 
was of sound mind ;" and subsequently, on being pressed 
hard for a more explicit statement, he concluded, " I pre- 
sume the Deity is of sound mind, and he alone." This is 

mental; requiring, and indeed admitting, only of moral remedies, in- 
stead of these forming only one class of curative agents ; whereas the 
brain is the mere organ of the mind, not the mind itself: and its dis- 
order of function arises from its ceasing to be a proper medium for the 
manifestation of the varied action and passion of the presiding spirit. 
And strange as it may seem, this error has been consecrated by a de- 
sire to escape from the fallacies of materialism. Yet it is manifest 
that they alone are guilty of the charge of attachment to materialism, 
who consider the disorder of the cerebral functions as mental, for then, 
indeed, the brain must be mind itself, and not simply its organ." — 
Christian Observer, vol. xxix. p. 266. 



8 WHAT IS INSANITY. 

next to asserting that no palpable distinction exists, no 
line of demarcation can be traced between the sane and the 
insane. It must be confessed, that the line is either ideal 
or purely geometrical. If the two most widely separated 
conditions of mind, its greatest strength and serenity, and 
its most abject imbecility or fury be contrasted, the distance 
appears enormous and impassable ; but if we gradually re- 
cede from these extreme points towards the medium, it will 
be found, so imperceptibly do the distinctive marks disap- 
pear, and so insensibly do eccentricity on the one hand, 
and enthusiasm on the other, blend together, that the task 
of declaring this to be reason and that insanity is exceed- 
ingly embarrassing, and, to a great degree, arbitrary. 
People have puzzled themselves to discover this line, a terra 
incognita, in fact, which does not exist ; the mind being sus- 
ceptible of as many shades of difference in the strength and 
relations of its powers as the body ; and the attempt being 
as feasible to define the precise health-point in the one as 
in the other. Another enigma has been propounded of 
somewhat similar import. An enigma which GEdipus could 
not have solved. It is to establish a definition of insanity. 
That is, to discover one form of words expressive of the na- 
ture of a hundred different things. I humbly think, that 
however interesting and edifying these investigations may 
be to mere philosophers, the philosophical practitioner ought 
to make the inquiry invariably bear reference to the ques- 
tion, whether isolation would be for the benefit of the pa- 
tient. The criteria, however, in forming a judgment are 
supposed to be various and adequate. Is a man able to 
manage his own affairs, is he violent, virulent, extravagant 
or troublesome? are the questions addressed to medical 
witnesses. It is rarely demanded, whether confinement will 
conduce to the restoration of health. That incompetency 
for business, or irritability, do occasionally require the in- 
terference of the law, may be true. Property and the 



WHAT IS INSANITY. 9 

public peace of society must be protected. And where 
either the one or the other is threatened, or disturbed, no 
difficulty can be experienced as to the propriety of coercing 
the violator. Insanity is evidently the cause of such out- 
rages, and insanity of a kind that cannot be efficiently treated 
without isolation. But even in such cases, the offender 
sometimes proves to be a delinquent : a criminal rather than 
a lunatic, and an Asylum becomes more of a penitentiary 
than an hospital. This is a minor evil. A much greater 
results from the universal application of such tests leaving 
lunatics at liberty, and incarcerating sane, or comparatively 
sane, individuals. This will be better understood from the 
following illustrations. The cunning vindictive maniac, for 
example, may be perfectly competent to conduct mercantile, 
or even more complicated affairs, with ability, he may even 
prosper in his enterprises ; and yet his treatment of those 
dependant upon him, of all who may have offended him, of 
all whom he suspects, may be marked by the maliciousness of 
the demon, and the indiscriminate ferocity of the maniac. 
He, if subjected to such tests, may never be suspected, un- 
til some out-burst of fury, when he is deserted by his habi- 
tual caution, consigns those around to death or misery. 
This man ought to be confined, but escapes, until the evil 
is done. Again, the man who from natural inaptitude to de- 
tails of business is incapable of conducting his affairs ad- 
vantageously, may be in all other matters rational and praise- 
worthy : he may be a good mechanician, an artist, a man of 
strong affections and irreproachable manners. This man 
ought to be free, but being subjected to the same tests, is 
confined, until his whole mind is as much enfeebled as his 
business powers. All chances ought certainly to be in fa- 
vour of the lunatic ; for a greater injury is done by the sa- 
crifice of one sane individual, than by the freedom of many 
lunatics. The test ought to be as general as possible, and 
to have reference not to the abstract question of what insani- 



10 what is insanity. 

ty is, but to the probable consequences which may accrue 
from the declaration that it exists in every given case. 

Entertaining these opinions then, in place of endeavour- 
ing to define, I have described the different forms which 
insanity assumes, believing that by such a course the inte- 
rests of science and of humanity will be better served, than 
by straining after what the failure of all previous writers 
nearly proves to be a nonentity. 

As an enlightened system of classifying lunatics must 
depend on the accuracy of the classification of the varieties 
of the disease with which they are affected, I have here pre- 
sented three : the most ancient, at least the most ancient 
which has any pretensions to be complete, the most recent, 
and the best. We shall adhere to the latter. 



I. Arnold's Table of the Species of Insanity. 



I. Ideal. i. 


Phrenitic. 


IX. 


Incoherent. 


III. 


Maniacal. 


IV. 


Sensitive. 


II. Notional, v. 


Delusive. 


VI. 


Fanciful. 


VII. 


Whimsical. 


VIII 


, Impulsive. 


IX. 


Scheming. 


X. 


Vain or Self-important. 


XI. 


Hypochondriacal. 


XII 


Pathetic. 




1. Amorous. 




2. Jealous. 




3. Avaricious. 




4. Misanthropic 




5. Arrogant. 




6. Irascible. 




7. Abhorrent. 




8. Suspicious. 



WHAT IS INSANITY. 1 L 

II. Notional continued. 

9. Bashful. 

10. Timid. 

11. Sorrowful. 

12. Distressful. 

13. Nostalgic. 

14. Superstitious. 

15. Fanatical. 

16. Desponding. 
xiii. Appetitive. 

II. Heinroth's Division of Insanity. 

I. Disorders of the Moral Dispositions. 

1. Exaltation, or excessive intensity. 

Undue vehemence of feelings, morbid violence of passions 
and emotions. 

2. Depression. 

Simple melancholy, dejection without illusion of the un- 
derstanding. 

II. Disorders of the Understanding, or intellectual faculties. 

1. Exaltation. 

Undue intensity of the imagination, producing mental illu- 
sions and all the varieties of monomania. 

2. Depression. 

Feebleness of conception ; of ideas. 
Imbecility of the understanding. 

III. Disorders of voluntary powers, or of propensities, or of will. 

1. Exaltation. 

Violence of will and of propensities ; madness without le- 
sion of the understanding. 

2. Depression. 

Weakness, or incapacity of willing. 
Moral imbecility. 

Note.— To these unmixed forms others are added under e&ch division, 
displaying combinations of several simple varieties. 






.i 



12 WHAT IS INSANITY. 



III. The Author's Arrangement. 

I. Idiocy. Non-development of faculties. 

] . Gradation. Non-development of all the powers. 
2- ~~~ External senses developed. 

3. ~~~ A propensity or affection developed. 

4. An intellectual power developed. 

II. Fatuity. Obliteration of Faculties. 

1. Partial. 

2. Complete. 

III. Monomania. Derangement of one or more faculties. 



1. Satyriasis. 

2. Homicidal and destructive. 

3. Proud. 

4. Vain. 

5. Timid. 

6. Cunning and suspicious. 

7. Religious and superstitious. 

8. Desponding and suicidal. 

9. Imaginative. 

10. Avaricious. 

11. Benevolent or affectionate. 

SECTION II. 

12. Incapability of perceiving relations of ideas. 

13. Incapability of perceiving relations of external things* 

14. Incapability of perceiving qualities of external objects. 
IV. Mania. Derangement of all the faculties. 

1 . Mania with increased activity. 

2. Mania with diminished activity. 

I. Idiocy. The first of these classes comprehends the 
manifestations of all those unfortunate beings, who, dead 
to sensation, or, with the external senses perfectly faithful 
and active, appear to possess no mind to which the impres- 



I 



WHAT IS INSANITY. 13 

sions thus received can be communicated, or one so closely 
assimilated to that of the lowest gradations of animal exist- 
ence, that the impressions pass away without becoming 
objects of thought, or causality, and without calling forth a 
single propensity or sentiment. The mind may not be, nay 
rarely is, so utterly undeveloped as this description would 
convey, but, while there may remain an attachment to some 
favourite place or person, or a delight in harmonious sounds, 
or constructive powers, or the irritability of anger, every 
other faculty is blotted out : no appeal can be made to rea- 
son, no progress can be made in education, there is, in fact, 
nothing to educate. So great, occasionally, are these pri- 
vations, that the individuals cannot articulate, nor acquire 
language, and literally do not differ, we repeat, from the lower 
animals, with which they delight to associate.* Hitherto 
these helpless creatures have been permitted to remain at 
liberty, the sport of fortune or of their own imperfect in- 
stincts and ill-regulated passions, the prey of the designing, 
the butt of the idle, or the cruel. According to a public 
print,t two individuals of this neglected class who had long 
roamed through llosshire, quarrelled, fought, one died of the 
wounds received in the struggle, and the other was, of course, 
consigned to prison. This took place in January 1835. 

Rational and true humanity would have suggested their 
protection from these sources of pain and annoyance by 
seclusion, where their humble and limited wants might be 
supplied, their wishes, so far as might be compatible with 
their safety gratified, and all the vegetative happiness of 
which they are susceptible, secured. 

There are, however, gradations in the scale of idiocy. 
Certain individuals advance farther towards the maturi- 

*Art. " Idiotisme," by Esquirol, Diet, des Sciences Med., vol. xxiii. 
— Pinel on Insanity, Eng. Trans., p. 126 — 169. — Voisin, Journal de 
la Socie'te Phrenologique de Paris, April 1835. 

f Scotsman, January 1835. 



14 WHAT IS INSANITY. 

ty of mind than others, and yet fall infinitely short of what 
our intellectual nature is intended to be, and even what the 
most neglected and degraded sane individual actually is. 
The lowest state in which humanity appears, is when neither 
reason nor sensation has been bestowed. Where the im- 
perfect being does not appear to be conscious of light, or 
sound, or hunger, and where sleep and a swaying motion of 
the body alternate, during the long protracted lifetime which 
many of these unfortunates are required to endure. The 
next gradation is where the external senses exist, but with- 
out the co-existence of any faculty by which the sensations 
thus obtained can become objects of reflection. The indi- 
viduals of this class prefer light to darkness, experience great 
pleasure from odours, and occupy a great part of their time 
in moving their hands along smooth surfaces, an act which 
in the child is supposed to contribute to the idea of exten- 
sion*. The third gradation consists of patients, who, besides 
exercising their senses, contract affections, display desires, 
and feel the first throbs of ambition. The last gradation is, 
where in addition to these feelings, there is a certain, but very 
contracted power of ratiocination, a facility in acquiring a 
mechanical art, or an aptitude for arithmetical or mathema- 
cal studies, without any corresponding evolution of the 
other powers of mind. 

II. Fatuity is generally the effect of apoplexy, chronic 
inflammation of the membranes of the brain, or of some sig- 
nal alteration in the texture of the nervous substance. The 
extent to which such deviations from the healthy condition 
of structure may be borne with impunity, has not been as- 
certained. But whenever both hemispheres are implicated, 
and the parts affected are actually disorganized, the annihi- 
lation, or, to avoid any mistake as to our meaning, the sus- 
pension of mind inevitably follows. It should be understood 
that these alterations are general and not local, or are at 



WHAT IS INSANITY. 15 

least of such a nature as to affect the whole of the contents 
of the encephalon. 

The progress of the malady is often slow, always insidious. 
Haifa lifetime may elapse, marked by gradually increasing 
inconsistencies and imbecility, which are kindly attributed 
to humour or eccentricity, before the understanding is sus- 
pected to be undermined, or the glaring approach of a se- 
cond childishness be more than surmised. When the keen 
and easily awakened sensibility of affection is struck by some 
unusual petulance, loss of attention, or inability to exercise 
judgment, the source may be conjectured, but some momen- 
tary gleam of returning reason, or the occurrence of circum- 
stances where, from there being no demand for intelligence 
the mental weakness may not be betrayed, will lull the fears 
to sleep, and not until after repeated follies and irregularities, 
does the truth, that an utter obliteration of the faculties is 
on the eve of taking place, become manifest. Even when 
succeeding another form of derangement, which very fre- 
quently happens, the decay steals on as insensibly as the 
approach of old age. The amount of deprivation can only 
be measured by comparing distant periods. Furious mania 
is probably more exposed than other varieties to this termi- 
nation. The change in this case is indeed astounding : 
when the outrageous, ungovernable desperado loses his attri- 
butes one by one — suffers first the extinction of the memory 
of his grievances, then of the inclination to hate or injure, 
and ultimately sinks into complete tranquillity and reverieism. 
Men of genius often share a similar fate, and from a similar, 
though, in their case, a voluntarily incurred affliction. They 
overtax, exhaust, and destroy their powers. And the con- 
trast here is still more distressing. The brilliant wit, the 
impassioned orator, even the calm philosopher become dot- 
ards, imbeciles, puling children, and by their own act, by 
their own ignorance of the mind, which they pretended to 
improve and ennoble. 



16 WHAT IS INSANITY. 

Fatuity may be partial or complete. It may comprehend 
one or all of the intellectual energies, and enfeeble all or de- 
stroy all. The powers may remain, but their strength, and 
especially the strength acquired by cultivation, is gone. 
They no longer act in concert ; and the indistinct descrip- 
tion of a discovery in mechanics, or a transaction in busi- 
ness, is associated with a prayer, or a passionate ejaculation. 
Some solitary power, or accomplishment, or favourite train 
of thought occasionally lingers behind the rest, or survives 
their destruction. Imbecile weavers are sometimes met 
with, who occupy themselves with the trade in which they 
have been originally trained. Musical imbeciles, and affec- 
tionate but one-ideaed imbeciles might be mentioned, who 
diffused a happiness around them which they did not feel, 
and from their peculiarities created a bustling and merry 
activity among their companions in which they could not 
participate. But as great infirmity of frame, in the majority 
of instances, accompanies fatuity, a more insurmountable 
obstacle is opposed to such manifestations than even the in- 
trinsic decrepitude of the mind itself. Dementia and gene- 
ral paralysis go hand in hand, and patients borne down by 
such complicated misfortunes, are seldom able to leave their 
beds or chairs.* From this circumstance, and from being 
at once harmless and independent of society from the extinc- 
tion of their social powers, a separate ward is appropriated 
to their use in many hospitals, where their existence glides 
on towards its peaceful but humiliating close, undisturbed by 
cold, or hunger, or darkness, or pain, or any of the few 
strictly animal irritations of which they are susceptible. 
Notwithstanding the apparently hopeless condition of pa- 
tients labouring under fatuity, cures occasionally take place. 
Their rarity may be gathered from the fact, that of 518 cures 
effected at Charenton, only four of those restored had been 
Fatuous. 

* De la Paralysie considered chez les Alienes par L. F. Calmeil. 



WHAT IS INSANITY. 17 

III. Monomania. The attempt to. reduce the tints, and 
shadings, and combinations of tints which meet the eye, to 
the rudimentary colours, must appear to the unscientific 
impossible. In the same way to a stranger who examines a 
populous asylum, and perceives the thousand modifications 
of disease of the moral sentiments and feelings which are 
there presented, a classification of these under some ten or 
twelve primitive powers or states of mind, must appear suffi- 
ciently daring. Yet by the aid of a careful analysis this 
may be readily done. You will not find the delusions of 
two madmen alike, is a common remark. True, the particu- 
lar succession of ideas will not and cannot be the same, for 
that is determined in each case by education, pursuit, and 
extraneous circumstances ; but the source, the emotion, by 
which these ideas are suggested, and in consequence of the 
derangement of which they are morbid, will frequently be 
found to be identical. One man conceives himself to be our 
Saviour, another that he is Louis XIV. ; the first rails 
against his imaginary persecutors, his fellow-patients, whom 
he designates unbelieving Jews ; the second pays court to 
the chambermaid as Madam de Maintenon, or mourns over 
his defeat at Blenheim ; the one walks about without shoes 
or stockings ; the other has turned his coat inside out as a 
fitting vestment for royalty. Two cases can scarcely be 
imagined more remote in their characteristics ; but if the 
deportment of each be traced back — if the assumption of 
elevated rank, the mock dignity, the hauteur, be analyzed, 
excessive activity of the feeling of self-esteem, accompanied 
by an inability to perceive the relations subsisting between 
the impressions in the mind and real circumstances, will be 
discovered to be the ultimate cause, and adequate to account 
for all the phenomena. Pride acting in the one case, on 
dispositions originally religious, and strengthened by culti- 
vation ; and pride, acting in the other, on the ambitious 
longings of an enthusiastic spirit. If all cases of insanity be 



18 



WHAT IS INSANITY. 



dealt with in a similar manner, the specific distinctions 
shrink within a very small compass. 

Before proceeding to sketch a few of the distinctive marks 
of the varieties of monomania, it is expedient to warn you that 
this term is generally understood in a sense altogether unphi- 
losophical. It is applied to cases where there exists only one 
delusion. And it is intended to imply the disease of only one 
power. Should a man declare himself to be Julius Caesar, 
and be clear, and consistent, and cogent on all other points, 
he is called a monomaniac, and is concluded to possess all 
his powers sane and sound, except the feeling of pride. The 
conclusion is erroneous. Pride communicates nothing more 
than a vivacious, an intense feeling of haughtiness and dis- 
dain, a desire for exaltation ; but the delusion whereby this 
desire is gratified, on a supposed metempsychosis into the 
body of the Roman emperor, must result from the diseased 
a"ction of the intellectual powers, — from an incapability, in 
fact, of perceiving the relations of ideas. A feeling cannot 
give an idea that a man is a different person from what he 
actually is. The word, then, is not here restricted to one 
delusion, but means the disease of certain classes of men- 
tal powers, in contradistinction to mania or disease of the 
whole. 

1 Sect. I. — 1. Satyriasis. The first form of Monomania, to which 
it is necessary to advert, is Satyriasis, or inordinate sexual desire 
uncontroled and incontrolable by any governing power within, 
or by admonitions, threats, punishment or coercion. This 
loathsome and most humiliating spectacle is fortunately rare, 
and occurs in consequence either of organic alteration in the 
brain, or of a long course of debauchery. We forge the bolt 
that is to destroy us. The history of mental disease reveals 
awful truths. And one^f these is, that the mind may be train- 
ed to i nsan ity, to destroy itself. And by the wise and ever just 
arrangements of Providence the punishment is proportioned 



WHAT IS INSANITY. 19 

to the offence, the effect corresponds in nature and in de- 
gree to the source from which it originated, the awards of 
justice are inflicted on the criminal by means of the very- 
weapon with which his offence was committed : he cultivat- 
ed his passions and propensities, and these, on arriving at 
the maximum of their energy, destroy him. Nay more, it 
would appear that the lower the propensity to the gratifica- 
tion of which his other powers have been but ministers, that 
the more gross and injurious the violations committed against 
the powers which regulate his own being, or connect him 
with his fellow-men, the more signal and striking is the ter- 
mination to such a career, the more grovelling and disgust- 
ing the condition to which the offender is reduced. Has 
sexual appetite polluted and paralyzed his mind ? He be- 
comes the victim of a loathsome species of mania, to charac- 
terize which we have been obliged to borrow the name of a 
fabulous monster from the Roman mythology. 

The erotomaniac is generally furious and inaccessible to 
any moral influence ; the mind is concentrated upon one 
point, and, as is always the case when profoundly affected, 
is blind and deaf, and closed against every less powerful 
motive. Sometimes there is mere sallacity attended by 
shame at the degradation of such an enslavement, — a con- 
viction of the diseased condition of the feelings, — a struggle 
to resist the incursion of the attack, and long intervals of 
health. All objects which address, excite the propensity ; 
all alterations in the functions of the system which tend to 
produce plethora or irritation, and all associations which 
divert the mind from occupations purely intellectual, are 
calculated to give force to the disease. Conceive, then, the 
situation of a maniac of this description in an institution 
where there was no separation of the sexes, little attention 
to the connection of the nervous system with the other 
functions, and no employment. Instances of pure mono- 
mania of this kind are certainly rare ; but the inordinate 



20 WHAT IS INSANITY. 

desire is often exhibited where other morbid feelings have 
the predominance and give a name to the disease. Here 
the regulating faculties are extinct, or suspended, and the 
passions assume the sway as the only, or most energetic 
mental impulses remaining, in the same way as a craving 
for food, or pleasurable sensations, rise above the general 
wreck in imbecility. Certain powers only, however, may 
suffer obscuration. The suggestions of these, although un- 
diseased, become vitiated by the over-ruling propensity ; 
they become instruments at the disposal of a mightier ener- 
gy ; they are bent from their natural course and directed to 
objects, and visions, and hopes, and fears, which sympathize 
with the impulse. Recollections, in themselves pure and 
connected with periods or events long antecedent to the 
commencement of the disease, are inextricably mingled 
with the existing gross conceptions. Trains of associations 
wliich originate in subjects the most remote from lascivious- 
ness, and appear to tend towards an elevation of sentiment, 
are found actually to terminate in and to inflame the feel- 
ing. The dreams are voluptuous. Even the automatic 
movements of the body are indelicate or indecent. The 
terminations of this form are three. The victims are either 
cured, sink into fatuity, or exhibit symptoms of another and 
more benign species of insanity.* 

2. Homicidal, or destructive mania, is asserted to be more 
prevalent in this country than elsewhere. Were we inclin- 
ed to form our opinion on the revolting descriptions con- 
tained in a book, once too popular, we might conclude 
every second or third madman to be ferocious, sanguinar}', 
a maimer, a murderer, or a parricide.f But this is not a 
correct exposition of the case. The Asylum from which 

* Dictionnaire de Me'decine, Art. " Satyriasis," " Folie," vols. xix. 
and viii. BufFon, vol. i. p. 222. Smellie's translation. Heckar, 
Epidemics of the Middle Ages, p. 105. 

•j- Sketches of Bedlam. 



WHAT IS INSANITY. 21 

these sketches were drawn was a receptacle for criminal 
lunatics, and, to a certain extent, adhered to the old regime 
of manacles and punishment which render men furious and 
dangerous. Our national character may render us more 
prone to this than to other forms of alienation ; and the pre- 
sent demoralised habits of certain sections of the population, 
their dog-fights, bull-baitings, pugilistic contests, and so 
forth, may assuredly predispose to the excitement of the 
very lowest passions; but my own experience would lead 
me to believe that homicidal mania is as frequent in France 
at least as in Britain. The lowest and least formidable de- 
gree of this malady is an irresistible inclination to destroy 
clothes, furniture, every article that will tear or break. This 
instinct attends the acute stage of many species of mania, 
but I here speak of it as idiopathic and permanent. A man 
who was otherwise tolerably well, once told me that the 
only words he liked to use, and the only things he liked to 
do, were " crush, smash." The second variety is where the 
patient is incorrigibly quarrelsome ; where he seeks grounds 
of dispute and antagonists ; throws all around into turmoil 
and confusion, and will fight with his shadow rather than 
allow his aggressive powers to continue dormant. The 
third variety combines with these qualities an indomitable 
hatred to human life; the thirst for blood is insatiable, arid 
every other feeling seems subdued by the desire for victims. 
In many countries and codes of law the majority of those 
horrible atrocities which place man below the level of the 
tiger are attributed to madness, and their perpetrators are 
committed to the charge of the physician instead of the exe- 
cutioner. For a long period the Romans had no law against 
parricide. They thought the crime impossible. That the 
insane have been immolated as criminals there exists too me- 
lancholy proof; and whenever an adequate motive is want- 
ing to explain the commission of such an act, or where the 
act is opposed to the generally prevailing motives of the 



22 WHAT IS INSANITY. 

actor, it is certainly humane and just to consider him as 
irresponsible.* Without entering into the legal question, it 
is necessary to observe that there exist very marked dif- 
ferences in the mental condition of individuals instigated by 
this blind impulse. There is the intense desire to kill ; but 
at the same moment a sympathy for, a wish to save, and an 
effort to warn the intended victim. There is this desire 
without any such sympathy, but attended with a violent in- 
ternal struggle to resist the temptation. And again, there 
is the desire unmitigated either by sympathy or struggle, 
burning for gratification, pausing, it may be from fear, but 
ever watching for opportunities. Examples of these dis- 
tinctions occur every day. Dr. Otho of Copenhagen relates 
that Peter Nielson, the father of seven children, was seized 
with a desire which he felt he could not resist to destroy 
four of his children, whom, nevertheless, he tenderly loved. 
Me took them to a turf pit, and after passionately embracing 
them, pushed them into the water and remained until he 
saw them drowned. Esquirol had a patient who acknow- 
ledged that he experienced a desire to shed blood, and espe- 
cially that of his own friends, to whom he was, notwithstand- 
ing, much attached. He deplored the tendency ; but could 
only frustrate his own designs by crying, when the fit re- 
turned, " Mother, save yourself, or I will cut your throat." 
The third degree may be illustrated by the history of a 
man given by Dr. Caldwell. He had been guilty of nine 
murders, the whole of which he acknowledged he had com- 
mitted from an inherent love of slaughter. The flowing of 
blood he declared to be " delightful to him." To such desola- 
tors, or rather to the absence of any attempt to distinguish 
and separate them from their less blood-thirsty or vindic- 

* Simpson on Homicidal Insanity : Appendix to Necessity of Po- 
pular Education. Archives de Medecine, vol. viii.p. 177. Georget's 
various Medico-legal works. Annales d'Hygiene Publique et de Me'- 
decine Legale, vol. xv. p. 128, and vol. xvi. p. 122. 



WHAT IS INSANITY. 23 

tive associates, is the loss of life in asylums to be referred. 
Within the last twenty years, two medical men and many 
keepers and patients have been sacrificed from this cause. 

The secondary incentives to, or reasons for such desires, 
are very numerous. One deadly blow is inflicted to save 
the soul of the sufferer, another is given to rid the world of 
a monster, and a third that a sacrifice may be offered up for 
the sins of all concerned. The effect which companions 
entertaining, and known to entertain such designs, must 
produce upon those labouring under the mania of fear or 
despondency, must be most distressing. To have the keen, 
cruel, blood-thirsty gaze of the glaring eye : the grinding 
teeth, the clenched hand, and the threats of vengeance of 
such a being constantly obtruded on the attention, might 
excite madness. It may be supposed that patients of this 
disposition are beyond the pale of humanity — beyond the 
reach of art, or of alleviation. It is not so. They may be, 
and often have been, humanized. By aiding the sympathy, 
the virtuous resolves and sane convictions during the 
struggle — by binding the mind to a certain routine of 
purely intellectual or mechanical tasks, and thus excluding 
the operation of the propensities, these unfortunates have 
been reclaimed, have been intrusted with instruments which 
might have served to wreak their fury, and finally have been 
replaced in that position in society from which they had 
fallen.* 

3. Monomania of Pride, &c. There may be in this variety 
either the exaltation of the emotion of self-conceit — the deep 
and impregnable notion of superiority, and indifference or 
contempt of all that is beneath, or that does not minister to 
egotism, or to the affairs of the egotist, — or there may be 
these feelings, coupled with delusions as to the character, 

* Medecine Legale relative aux Alienes et aux Sourds-Muets 
par J. C. Hoff bauer, p. 135. — Note sur la Monomanie Homicide par 
M. le Docteur Esquirol. 



24 



WHAT IS INSANITY. 



circumstances, rank and claims, upon which this pride i 
based. The self-satisfaction may be felt, the inattention t 
business, the squandering of property, and other irratiom 
acts, may be resolved upon by the lunatic in his own prope 
person, or as a king or a conqueror. The latter is the mos 
frequent form. There is, however, in the most pertinaciou 
contenders for imaginary rank, no loss of the consciousnes 
of personal identity. The individual may conceive himse; 
to be Socrates or Sappho, a prince or a philosopher. H 
may conduct himself with all the dignity, and speak an 
think, as far as his abilities admit, in keeping with the as 
sumed character, and spurn the slightest insinuation tha 
Socrates is dead, that he himself is A. B., or that there is n 
real ground for his pretensions. But should his friends b 
presented to him, they are recognized and received as such 
or should old scenes and former associations be recalled, h 
will uniformly place himself in the same relation to these a 
when they were previously before his mind. He will, fo 
example, readily describe how Socrates sold a sheep t 
CD., or took a dose of medicine at a certain time, and ii 
a certain place, but will never dream of referring the sale c 
the sheep to the pastures of Mount Hymettus, or the swal 
lowing of the drug to the prison of the Acropolis. I hav 
under my care a female, who declares herself to be the wif 
of George III. ; but then it is as Queen Elspeth, born in tfo 
parish of Benholm, that she ascended the throne. Thi 
proud maniac, where his peculiar reveries or hallucination 
are not combined with other feelings, is generally silent, am 
is regarded as sullen. He is wrapped up in the magnificent 
of his own importance and authority, or in the contempla 
tion of his own attributes. He is independent of the world' 
humility or kindness : he feels himself immeasurably remov 
ed from its approaches, and despises the trifles which engag< 
its inhabitants. But he is not unapproachable. Regulat< 
your advances by the prevailing feeling of his mind, whicl 



WHAT IS INSANITY. 25 

must be the foundation of all intercourse ; put into your 
addresses that respect and deference which he demands ; 
appear by the tone and style of your remarks to admit the 
point at issue between him and the sane part of the com- 
munity, and you will perhaps find him a condescending 
patron, an adviser, or a protector. His happiness resides in 
thoughts of personal magnificence : he is, therefore, con- 
cluded to be selfish. But it is not the selfishness of aggran- 
dizement or monopoly. His most marked symptom indeed 
is, that within himself centre so many excellencies, that he 
can dispense with all the ordinary objects cf man's desire 
and ambition. He neglects his dress, he is solitary, he 
seeks no kindness ; for what avails the foreign aid of orna- 
ment, or companionship, or attention, to one who possesses 
unbounded wealth, a descent of twenty quarterings, the 
wisdom or the eloquence of all antiquity, everything, m 
short, which nature or fortune could bestow. Such are his 
delusions : they may, nay, must be varied, by the constitu- 
tion and cultivation of his mind ; but they will be found to 
revolve without deviation round one point, the feeling of 
pride. The ease with which such patients are bent from 
their own purposes towards those of others, by persons who 
understand the human mind, and can use their knowledge 
practically, is beautifully shewn in a statement of Pinel's. 
He had no less than three Louis Sixteenth's in Bicetre at 
one time. Their majesties unfortunately met in the court- 
yard : a dispute ensued as to the right that each respective- 
ly had to the title which they all assumed : and as a scuffle 
appeared likely to take place, the matron interposed, took 
one of the disputants aside, and said with great gravity, 
" How happens it that you should think of arguing with 
such fellows as these, who are evidently out of their minds ? 
we all know well enough that your majesty alone is Louis 
Sixteenth." The appeal produced the desired effect on each 



26 



WHAT IS INSANITY. 



real sovereign in succession, each retiring triumphant and 
supreme.* 

As a cause of insanity, wounded self-love, under the dif- 
ferent aspects of disappointed ambition, jealousy, and insult, 
is prolific. Of 492 cases given by Esquirol, sixty-one, or 
about one-eighth, were attributable to these states of feel- 
ing.f 

4. Monomania of Vanity. Consists in an irrepressible 
craving for praise, homage, and admiration. This is the 
original germ ; but from this there spring a thousand gro- 
tesque manifestations of the appetite and the modes by which 
it shall be gratified. The actions of the great are imitated, 
their manners travestied, and there is an affectation of all ac- 
complishments and virtues, with the view of extorting ap- 
probation. The courteous bow, the rakish swagger, the 
ostentatious display of a scrap of old ribbon, are all intended 
to' excite astonishment and admiration. The mind's errors 
all tend towards what is called eclat : they bear reference 
to the judgment of the world. The vain lunatic often suffers 
a moral metamorphosis as well as the proud ; but when 
imagination has suggested the delusion of being some very 
important personage, it is not enough : the qualities upon 
which this importance depends must be exhibited in order 
to attract notice. If the idea of a celebrated singer has 
predominated, the harshest notes will be screamed out in 
the hope of an encore : if the maniac be converted into a 
Demosthenes, you are assailed with the most incoherent, 
but probably the most impassioned harangue that ever fell 
from the lips of the most enthusiastic and successful orator: 
if a person of fashion be imitated, rags are arranged in their 

* Pinel on Insanity, p. 96 Davies' Trans. 

•f Observations on the Nature, Kinds, Causes, and Prevention of 
Insanity, &e. By Thomas Arnold, M.D-, vol. i. p. 251. 



WHAT IS INSANITY. 27 

most elegant folds — ribbons, and stars, and orders, load the 
breast — there is the mincing step, the stoop, the lisp — all 
the frivolity of the character: if kingship be personated, it 
will be popular kingship ; for although legitimacy may suf- 
fice the proud, popularity, or living in the hearts of the 
people, will alone satisfy the vain maniac. He is a cringing 
beggar for the smallest mite of respect. 

Females are more subject to this description of derange- 
ment than males : and the French hospitals are crowded 
with examples. These facts are accounted for by the 
strength of the feeling of vanity in the female sex, and by 
the injudicious encouragement which it receives from the 
present state of society. The misery of this class of lunatics 
is often extreme. They demand a tribute which is never 
paid, and which it might prove injurious to pay. Their dis- 
appointment is acute. They are discomfited to find that 
their loathsome rags are not regarded as cloth of gold, their 
croaking voice as melody. This discomfiture may be turn- 
ed as a weapon against the disease.* 

5. Monomania of Fear. The agitation of fear and anxiety 
frequently produces the monomania of fear ; but the designa- 
tion here used refers to the nature, and not to the origin of 
the complaint. Its essence is vague, exquisite terror. It 
may be definite, and have an object, real or imaginary, 
frightful or not; or it may be an irrepressible apprehension 
of present or prospective evil, without any conception of 
what is feared, or why it is feared. The object dreaded, 
v/hen there is one, is external and connected with certain 
persons, events, or influences ; or it is internal, a part, a 
condition of the diseased mind itself. Hence, there is the 
fear of some persecutor, plot, or awful calamity ; or the 
mind quails at its own resolves, at what it is, at what it may 

6 Pinel. Quoted by Dr. A. Combe. — Observations on Mental 
Derangement, p. 174. 



28 WHAT IS INSANITY. 

become. Haunted by self-created torments, the lunatic 
spends his days in seeking protection, in attempts to escape 
from the incubus of ever-present danger — his nights in the 
anguish of abandonment and despair. The wailings which 
are heard in asylums, are oftener the petitions of the terror- 
stricken for succour, or inarticulate cries of consternation at 
what is seen, heard, or felt — than shouts of defiance, or ex- 
pressions of sorrow. The timid are likewise the most sleep- 
less inmates ; the night comes to them with its awe-inspiring 
darkness and silence, but not with its repose. The furious 
exhaust their muscular powers by their struggles during the 
day, and obtain the deep sleep of fatigue ; but the timid 
know no remission of misery, even during their disturbed 
slumbers — for their terrors rise up before them as vividly in 
dream as in their waking thoughts. The things dreaded 
are proteiform. Occasionally, the same delusion, be it a 
spectre, or the deep laid plan of a conspiracy, will remain 
for months or years. More generally, every circumstance 
is successively construed into a source of alarm, until no 
impression reaches the mind, save through this distorted 
medium. 

Fear is well known to render the system defenceless in 
the case of contagious diseases ; and while it actually causes 
many attacks of insanity, it predisposes to a still greater 
number. What I mean is, that the suspense, the apprehen- 
sion, the actual terror incidental to many situations of life, 
sap the foundations of mental strength, and leave the ner- 
vous system a prey to the exciting causes of mania. It ap- 
pears that of nearly five hundred cases of insanity depending 
on a moral cause, forty-six or one-eleventh proceeded from 
terror. A fact not less illustrative of the influence of fear, 
is drawn from the history of the French revolution. Fe- 
males, although they did not share so prominently in the 
dangers of that period, could not escape from the panic and 
misery which it created. They heard the howling of the 



WHAT IS INSANITY. 29 

tempest, though they felt not its fury. They had husbands, 
children to be guillotined, property to be confiscated, ties, 
and hopes, and happiness to be sacrificed. The consequence 
was, that an infinitely greater number of those who were 
pregnant at the time, gave birth to idiots, or children who 
afterwards became lunatic, than during times of order and 
tranquillity. The year 1793, in which the most frightful 
events of this convulsion took place, was likewise remark- 
able for the number of suicides. Fear is known, by those 
who have studied the feelings under which self-destruction 
is attempted, to be one of its most frequent causes. Strange 
to say, the apprehension of death itself leads to this act. 
" It would seem," says Reid, " as if they rushed into the > 
arms of death in order to shield themselves from the terror 
of his countenance."* Now, in Versailles, a town, the po- 
pulation of which even now does not exceed £0,000, and 
where the Revolution may be said to have commenced, and 
upon which it repeatedly recoiled from the capital, not less 
than 1300 suicides occurred during the year mentioned.f 
Public events, or private misfortunes often determine the 
character of the object feared. Dr. Voisin affirms, that in 
France, those who formerly would have trembled at ghosts, 
the guillotine or Robespiere, now fear the police. The 
timid maniac is little susceptible of cure ; but his sorrows 
may be soothed ; his desire for society and protection may 
be opposed to his imaginary horrors ; and the distraction of 
having something to do may be made to counteract the de- 
lusion of having something to fear.J 

6. Monomania of Cunning and Suspicion. Wonder is 
often expressed that madmen should say such shrewd, and 

" Reid's Essays on Hypochondriasis. 

t Art. Suicide, Diet, des Sciences Med. Burrow's Commentaries, 
p. 438. 

£ Perfect — Annals of Insanity, p. 243. Guislain, Traite sur les 
Phrenopathies, &c. p. 122. 



30 WHAT IS INSANITY. 

do such cunning things. Those who have felt any surprise 
at a circumstance so common, are ignorant, first, that the 
powers which give shrewdness may remain uninjured while 
all the others are extinct ; and, secondly, that cunning, the 
wish to mystify, deceive, or conceal, and likewise the sus- 
picion that deceit is practised or designed, is itself a modifi- 
cation of madness. We believe the terms cunning and sus- 
picious to be convertible ; for in mania, as in the healthy 
discharge of the mental functions, he who is disposed to 
over-reach is jealous of the intentions of others, and while 
shrouding his own feelings and projects, makes every effort 
to penetrate those which he suspects. The cunning maniac 
places no confidence in any one friend. He sees a sinister 
meaning in every act ; he gathers insinuations from every 
word ; he is the victim of some plot, the meshes of which 
surround him, but which he will break through and baffle. 
He will outwit all machinations. If a smile appears on the 
face of a companion, it is held to be a secret sign. If a let- 
ter is delivered in his presence, he is certain that it impli- 
cates him in some mysterious transaction. He glories in 
circumventing, in assuming an aspect different from the true 
expression of his feelings — in concealment and insincerity. 
His friends are his dupes ; and while he writhes under the 
idea of their falsehood and connivance, his delusions revert 
to schemes by which they may be deceived in retaliation. 
If in confinement, he may disturb the concord of a whole 
asylum, by disclosing conspiracies and schemes, and snares 
which have no existence but in his own suspicion. He will 
bend every energy to escape, and will display a great deal 
of ingenuity in devising the means. An old spoon will 
assume the office of a key to open the door ; a few stray 
threads will be converted into a rope to scale the walls, and 
some propitious moment will be chosen for the enterprise. The 
apartment, bed and wearing apparel of such aMephistopheles 
will afford ample proofs of his dominant propensity. Every 



WHAT IS INSANITY. 31 

thing will be hidden. Whatever he does will be attempted 
in secrecy, and the success of a stratagem will prove the 
maximum of enjoyment. Although men so actuated can- 
not well understand open dealing, candour and disinterested 
kindness — all marks of which they will believe to be the 
mask of a selfish purpose — yet they are accessible in many 
ways. Flattery, humanity, honour, command, may all, in 
different cases, find a responsive feeling in their breast. 
They may even be cajoled, deceived into an exercise of rea- 
son, although this should be the last resource. When cun- 
ning is associated with malicious or suicidal intentions, the 
case is distressing. A lunatic affected in this manner, known 
to cherish a design to destroy himself, and deprived of all 
ordinary means of executing his purpose, triumphed overall 
these obstacles in the following manner. He complained of 
a total want of sleep, restlessness, and headache. An opiate 
was prescribed. He every evening received about a grain 
of opium, and after a show of reluctance, put it into his 
mouth. He did not, however, swallow it. By retaining it 
in the mouth until his attendants left the room, he at last 
accumulated nearly a scruple, swallowed the whole, and 
died* 

7. Monomania of Religion and Superstition. The engross- 
ing sentiment in this variety is a blind devotion and awe ; 
the delusions rest upon the relation which the patient holds 
to Deity, his laws and providence, and to other supernatural 
beings. Acts of worship, really solemn, extravagant or hor- 
rible, according to the extent of the disease or the character 
of the other predominating feelings, are often attendant on 
the paroxysm. Vision seeing, miracle working, claims to the 
possession of the divine afflatus, are among the symptoms. 
The belief that as a missionary, a preacher, or a prophet, he 
is to achieve the conversion and regeneration of mankind, 

* Esquirol, Des Illusions chez les Alienes, p. 16. Guislain, p. 194. 



32 WHAT IS INSANITY. 

is ever before the philanthropic, while his personal interests 
and salvation are the cherished hope of the selfish maniac. 
The vagaries of the vacillating powers often lead the indivi- 
dual back to some far distant period in the progress of reli- 
gion ; and standing on a heap of rubbish, he imagines him- 
self a heroic Hebrew fighting for his faith on the crumbling 
battlements of Jerusalem ; or, transported to the palmy days 
of Rome, he declares himself to be the head of the church. 
In the majority of instances the delusion bears a resemblance 
to any recent demonstration of enthusiasm, or to any de- 
scription of fanaticism which may be current. When I stu- 
died at Salpetriere, the Jesuits were in deep disgrace ; the 
St. Simonians were popular and fashionable ; and almost all 
the religious maniacs admitted, laboured under the impres- 
sion that they were Jesuits or St. Simonians.* The minor 
features of this kind of derangement differ in different coun- 
tries, and as it occurs in different sects : the insane Catholic 
enfeebles his body with stripes and penance ; the insane 
Protestant is more contemplative, but in essential points the 
disease is the same in both. When complicated with the 
belief in the visitation, or interference of spiritual existences, 
fear may or may not be experienced. This is determined 
by the courage of the party, or the attributes of the being 
conjured up. The demon may be met by execrations, or 
shouts of joy, this matters not ; the deviation from health con- 
sists in the firm conviction that the eye sees what is the sha- 
dowy creation of a distempered fancy, and that the heart 
feels the inspiration and strength of divinity when it is agi- 
tated by its own erring suggestions. Lunatics affected in 
this manner appear to be supremely happy. The very in- 
tensity of their feelings protects them against anxiety or de- 
pression. They believe that their constant humility and 
adoration will be rewarded ; that they are favoured more than 



1832. 



WHAT IS INSANITY. 06 

other men, and that their communication with higher intel- 
ligences is proof and foretaste of this. This fine spun tissue 
of error cannot but yield joy and security. There are, ac- 
cordingly, few suicides from religious Monomania. Occa- 
sionally they do occur, and under circumstances which cor- 
respond to the peculiarity of the individual or of his situa- 
tion. A Venetian shoemaker conceived that he was destined 
to be a sacrifice for the human race. He prepared and 
planted a cross, procured a sponge, nails, spear, and in fact 
imitated the representations of the death of our Saviour so 
often seen in Catholic countries. He wounded his side, 
transfixed his feet and hands, and then raised himself up to 
the cross by some mechanical contrivance, and hung impaled 
for upwards of twenty-four hours before he was discovered. 
Wherever lunatics are collected together, a great many 
cases are always designated religious, and supposed to be 
attributable to enthusiasm. This partly proceeds from the 
difficulty of obtaining correct information as to the history 
of each case, and partly from the philosophical blunder of 
concluding that in insanity the cause is invariably of the 
same nature as the effect. We are the more anxious to ex- 
pose this error as it seems to set limits to religious instruc- 
tion, to the cultivation of pious dispositions, and to cast a 
doubt on the propriety of the promulgation of certain high 
and holy principles of our faith. Now all men must, and 
practically do, admit that the kind and degree of religious 
training should be adapted to the capacity and the education 
of the proselyte. By forgetting this principle, this " tem- 
pering the wind to the shorn lamb ;" and by treating the 
desponding and presumptuous, the weak and the strong un- 
derstanding alike, madness may have been produced. Yet 
even after allowing this system all the evil influence it can 
possibly possess, and adding to it the injurious effect of the 
theological speculation in which the ignorant engage, the 
cases of insanity produced by these means are comparatively 



34 WHAT IS INSANITY. 

few. Burrows states that no case of mania resulting from a 
religious source ever fell under his notice which could not 
be referred to the conflict accompanying a change of opinion 
in religion.* To every one who can analyze this proposi- 
tion, it must be clear that the tendency to insanity is given 
by the change, by the overthrow of long established princi- 
ples, and not by the nature of the thing from or to which the 
change is effected. A change in politics or fortune would 
be equally prejudicial. Scepticism produces a greater num- 
ber of maniacs than enthusiasm. The authority just quoted 
appears to coincide in this view, as he affirms that the cases 
of which he speaks were developed during the interval of 
doubt occurring between the relinquishment of old, and the 
adoption of new principles. But to appeal to facts. Es- 
quirol states, that of 492 patients insane from moral causes, 
in nine only could the alienation be traced to religious fana- 
ticism. This calculation was made in France at a period, it 
is true, when a moral pestilence had swept the feelings and 
symbols of Christianity from the land. Previous to this 
period, that is, during the desecrations of the revolutionists, 
the proportion was greater, Pinel attributes 25 in 113 cases 
to fanaticism. But now, when the ordinary tone and cha- 
racter of society and its institutions have been, to a certain 
extent re-established, that proportion has scarcely at all in- 
creased. Of 528 cases admitted to Charenton, from 1826 
to 1832, produced by moral causes, only 24 arose from 
" exalted devotion." In Hoist's tables, only 28 of 384 cases 
are traced to this cause. In this country, statistics are very 
deficient. Of 40 cases in a neighbouring institution, not 
one is referred to this origin. But I am convinced from 
observation, that although this cause does not operate more 
powerfully, the number of religious maniacs is greater in 
Britain than elsewhere. The explanation is obvious. Re- 

* Barrow's Commentaries, p. 88. 



WHAT IS INSANITY. §J 

Jigion has here its due exercise and awful importance ; the 
inind is trained, thinks and feels under its influence ; and 
when from misfortune or ambition, or physical injury, the 
place of reason is usurped, it may always be predicated, 
first that the delusions which succeed will correspond to the 
natural disposition, and secondly to those impressions which 
have been most powerful and permanent ; and hence there 
are not a greater number of maniacs ; but there are a greater 
number of maniacs exhibiting a certain class of delusions, 
because our countrymen are, whatever may be their errors, 
naturally and habitually devout." 

8. Monomania of Despondency and Suicide. This form is 
often classed with religious mania upon the very inadequate 
ground that the patient may accuse himself of inexpiable 
guilt, of having offended God, and therefore despond. But 
the derangement consists in the depression and prostration 
of energy ; the delusion of criminality, &c. follow, and are 
adduced but cannot be received as reasons for the disquiet- 
ude. The simplest form in which morbid despondency is 
manifested, is as a want of confidence in the talents and pro- 
spects which previously had been regarded with satisfaction ; 
an utter abandonment of hope, a miserable lethargic despair. 
There is no delusion or incoherence present; there is a set- 
tled and horrible conviction of the approach of ruin and de- 
solation, to which the mind gives itself up, against which it 
can make no effort, but for which no cause, not even an im- 
aginary one, can be assigned. This, when an individual has 
the fortitude to control, or the cunning to conceal the ex- 
pression of the full extent of his sufferings, or when they do 
not interfere with the common affairs of life, is called lowness 
of spirits. It ought to be regarded and treated as insanity, 
and not dreaded as its forerunner. For it is at this stage 
that suicide is resorted to. Should this not be the case, 

* Perfect, Annals of Insanity, p. 87. Arnold's Observations, p. 2*28. 



36 WHAT IS INSANITY. 

specific hallucinations may speedily appear, and the agony 
of mind will be indured as a consequence of bankruptcy, the 
unfaithfulness of a friend, the persecutions of enemies, or the 
ravages of an incurable disease. No demonstration of the 
untenableness of such grounds, no picture of brighter and 
happier circumstances will avail to refute or encourage. The 
sufferer clings to his hoarded misery. There is generally 
great loss of physical strength in cases of this kind ; and the 
pale, emaciated countenance, dull and sunken eye, and list- 
less dejected form, tell as plainly as the querulous complaint, 
or the long intricate description of sorrows and anticipated 
evils, to what class the patient belongs. These unfortunate 
beings are often persecuted by their fellow- maniacs, and have 
real added to imaginary sources of uneasiness. I have con- 
joined the cognomen of "suicidal" with this species of mad- 
ness, because the propensity to self-destruction appears more 
frequently in the desponding than in the religious, the sus- 
picious, or even the homicidal maniac. In a table given by 
Professor Casper of Berlin, 103 cases of suicide are attribu- 
ted to mental affections ; 30 of these may be classed under 
this head, and 32 under that of fear and despondency com- 
bined. In the same table, containing in all 412 cases, the 
causes of which were known, a corroboration of the opinion 
that suicide is rare among religious maniacs is found, one 
case only having followed religious excitement." In Paris 
where there have been 3185 suicides in ten years, and the 
annual mortality from this cause now amounts to 477, M. 
Guerry, the eminent and accurate writer on the statistics of 

* A somewhat different result appears to have been recently arrived 
at by Dr. Sc. Pinel. He has published a table in which 11 of 125 
cases of suicide depended upon religious excitement- His conclusions 
are, however, much less valuable and satisfactory from his having taken 
a particular class of suicides, that in which the attempt was unsuccessful, 
as the ground of his observations. But even waiving such an objection, 
the proportion is still small. 



WHAT IS INSANITY. 37 

crime, says that gambling, and of necessity the defeated 
hopes and dejection which it entails, produces a greater num- 
ber of self-inflicted deaths than any other cause. He ha- 
zards the opinion that it is almost the sole cause.* Next to 
despondency, offended honour and domestic disappointments 
appear as the most fertile source of suicide. But such rea- 
sonable causes do not always exist ; a mere disgust at life, 
an uneasy sensation, a disturbed digestion may be conceived 
by the unhinged mind sufficient to justify the act. Such 
reasons have been acknowledged by those who retained in- 
telligence to know and describe their intentions ; and it 
should be recollected that in proportion to the impairment of 
intelligence, the danger increases, for to him who cannot dis- 
tinguish the real position in which he stands, who cannot 
estimate either the present or future consequences of the act, 
and who is wholly delivered up to one series of ideas, or to 
two, pleasure and pain, the most insignificant event, the most 
ridiculous and incongruous motive, may precipitate the at- 
tempt. The desponding maniac consequently requires un- 
remitting attention. No ordinary precaution will frustrate 
the success of his designs, for every object may by ingenui- 
ty be turned into a means of destruction ; and the moment, 
apparently the most inauspicious, and from that reason the 
least suspected, will be chosen for the purpose. For years 
will such a design be cherished in silence, until the fears and 
care of those around are lulled to sleep, and then executed. 

I have noticed a very interesting fact connected with the 
utility of isolation and superintendence in this variety. We 
learn from Guerry that suicides are annually effected in Paris 
in the proportion of one to every 3000 inhabitants. This takes I 
place among individuals accredited sane, and in possession 
of many of the things which endear the continuance of life. 

* Essai sur la Statistique Morale de la France. The statements of 
M. Broue, Annales d'Hygiene Publique, vol. xvi. p. 243, do not 
countenance this view. 



■■ 



38 



WHAT IS INSANITY. 



Esquirol states, on the other hand, that among 12,000 luna- 
tics confined at Salpetriere, during a series of years, and ex- 
posed by their malady to constant temptations to escape from 
suffering by death, only four suicides took place ; that is, one 
in 3000. The proportion is apparently the same; but the ad- 
vantages of restraint, and the actually low rate in asylums 
must become manifest, when the circumstances of the cases 
and the conditions of the persons compared are considered.* 
9. Monomania of Imagination. This may be denned the 
mania of accomplishments. It is displayed in attempts to do 
every thing, and a pleased conviction that every thing is 
done perfectly. The maniac is a poet, a painter, a mathe- 
matician, as the case may happen, he pants after excellence,- 
and struggles indefatigably to attain it; he writes verses 
which would disgrace a valentine ; he scratches hideous 
figures on the wall, his calculations cover every slip of paper ; 
these efforts of his genius do not satisfy his longing after im- 
mortality, but he is resolved to improve. He lives in an at- 
mosphere where the distorted objects appear to him of gigan- 
tic size, sublime magnificence, and surpassing beauty. Every 
thing with him is superlative. This is the madness of Don 
Quixote. He does all odd and eccentric things to satisfy his 
humour, and if reprimanded for his extravagances, he will, 
in all probability, reply in some impassioned strain to the 
lady of his love, or to the keeper, as Shakspeare or the Em- 
peror of Morocco. He literally 

" Finds tongues in trees, sermons in stones." 

He is, to use a word in a new sense, a transcendentalist. His 
reasonings are so subtile as to escape the ordinary power of 
the mind's eye ; and his refinements upon excellence would 
astonish an optimist. His plans for human improvement are 
original, and on the grandest scale. Whatever is new he 

* Burrow's Commentaries, p. 412.— Perfect's Annals, p. 26 — 297. 
Falret du Suicide et de l'Hypochondrie. 



WHAT IS INSANITY. 39 

prizes, and, in fact, his grand desire and delusion is to act 
differently from the common herd, in order to do it well and 
with eclat. This, in less marked outline constitutes the od- 
dities and eccentricities of society. A Frenchman passed 
twenty years in cogitating a plan whereby the whole human 
race could be accommodated under one roof in one sumptu- 
ous building. The rulers were to reside in the centre, and 
the nations over which they presided were to radiate in their 
various interminable abodes from this point. His calcula- 
tions and arrangements for this vast pantisocracy were re- 
peated again and again, but on his pulling down his house in 
order to apply these practically, his splendid visions were 
dissipated by confinement. The disease evidently consists 
in the inordinate activity of those feelings called romantic 
which aim at an unreal, a perfect state of existence, without 
any counterpoise on the part of reason. Poets and novel 
writers have certainly done, or attempted to do much to- 
wards the elevation of the human race ; but over the unpre- 
pared, ill-balanced and sanguine mind, their works exercise 
a pernicious dominion, and sometimes cause the madness 
now delineated. In the Charenton table, thirteen cases are 
traced to novel reading.* 

10. Monomania of Avarice. This is not simply the vice of 
the miser in excess. There is the propensity to acquire, by 
any means, legitimate or otherwise, as well as the propensity 
to hoard. The day-dreams of avaricious lunatics are all di- 
rected towards wealth, property, or aggrandizement in some 
shape. Their air castles are built of gold. But although 
panting after riches, they may be styled omnivorous : they 
will derive pleasure from receiving or taking any article 
without reference to its nature or value. The only condi- 
tion necessary to secure this gratification being, that the 

* Tuke, Description of the Retreat at York, p. 182. — Perfect, An- 
nuls, p. 47. — Guislain snr les Phrenopathies, p. 204. 






40 WHAT IS INSANITY. 

coveted possession is not theirs, but is about to become theirs. 
They only, of all men, have discovered the philosopher's 
stone ; every straw and rag and pebble becomes precious, is 
transmuted into gold, or silver, or gem, when it passes into 
their hands. Did they actually possess this flux, their be* 
lief would be justifiable, that they are owners of half the 
land in the kingdom: that the occupants are appointed by 
them as agents ; that their food is served on plate and china ; 
and their straw pillow filled with rubies. The rooms they 
inhabit are littered, their clothes are loaded with collections 
of indescribable trumpery, which they hold to be of incal- 
culable importance. If possible these treasures are con- 
cealed, and the hiding places would puzzle a French police 
agent. The point of the shoe, the lining of the coat, the 
sleeve, the mouth, even the stomach, are made depositaries 
of these ill-gotten gains. They, of course, make no use 
whatever of such acquisitions ; it is the act of accumulating 
which constitutes their happiness. The pocket-handker- 
chiefs of every one who visited a large Asylum disappeared, 
no one could imagine how or where. At last they were 
discovered bound round the waist of an avaricious maniac, 
who had abstracted them so dexterously as to have eluded 
suspicion, and who, though from his notorious character he 
was searched every night, had outwitted the inquisitors by 
placing the stolen goods next his skin. Stealing is delight- 
ful to these men ; they rob their fellow-patients, seize upon 
everything within their reach, and boldly justify their con- 
duct on the ground that all they have taken is theirs de 
jure. In the supposed plenitude of an ample fortune, such 
men are sometimes generous. They offer to pay the board 
of all the patients, and the wages of all the servants in an 
asylum ; or present you with bills for an enormous amount, 
sometimes for your own behoof, more frequently for their 
own. For the last five or six years a patient has regularly, 
every week, presented the physician at Charenton with 



WHAT IS INSANITY. 41 

scraps of paper, designed to meet all the disbursements of 
that vast institution. It is almost needless to say, that this 
class of patients may be bribed to do any thing.* 

11. Monomania of Benevolence and Affection. — Even the un- 
restrained exercise of the powers giving a name to this variety 
must be classed with madness. It may be described as an 
over anxiety for the welfare of the whole human race, or for 
that of the narrower circle of friends and acquaintances. A 
visionary who neglects his own duties and concerns in order 
to eradicate poverty, and sickness, and sorrow from the world, 
or gives up his soul to anguish, because the attempt has failed, 
and the mother who, distracted for the safety of her children 
and acquaintances, can neither act, nor think, nor sleep, 
because she cannot relieve them from some evil or misery 
of which they do not complain, and by which they are sub- 
jected to no annoyance, are both instigated by similar morbid 
feelings. The affectionate maniac is a melancholy spectacle. 
There is a nobleness and magnanimity in his phrenzy ; he •" 
strips himself of his clothes ; he starves for days in order to ' 
relieve the supposed wants of his associates ; his mind teems 
with projects to alleviate their condition, to render them 
happy ; or he wanders about declaring that his whole kin- 
dred is destroyed, or in misfortune, and searches for their 
mangled bodies in every hole and crevice. They often look 
upon themselves as physicians, nurses, or overseers of the 
poor, and the asylum, or their place of abode whatever it 
may be, as an hospital, or house of refuge, where they are 
commissioned to diffuse comfort and contentment. Such 
ministrations are often highly beneficial ; but so far as the 
kind ministrants are concerned, the labour never ends, for 
they never fail to detect new wants and require to devise 
new methods to relieve them. Men of this stamp often 

* Guislain, Traitd sur les Pbrenopathies, p. 209. Esquirol, Des 

Illusions chez les Alienes, p. 18- 



■^^^■■■■■■■■■i 



42 WHAT IS INSANITY. 

squander a noble fortune before confinement is resorted to. 
As it is they who see the want and not the objects who feel 
it, the charities which they bestow must be indiscriminate. 
" To endow a college or a cat," affords to them nearly the 
same satisfaction. This, however, is the most pleasing 
view of the case. They are generally rendered unhappy by 
the delusions of wretchedness which are ever before them, 
but which they have no means to alleviate, and bemoan the 
hard fate of being unable to execute the munificent and mer- 
ciful behest for which they were sent upon earth. Or, torn 
by apprehensions for the misfortunes of friends, by disap- 
pointment from their want of affection, and by grief from 
their ingratitude, they commit suicide.* 

Sect. II. — 12. Incapability of perceiving the Relations of 
Ideas, — The second section relates to disturbance of the re- 
flecting and perceptive powers, and the first division of it to 
the incapability of perceiving the relations of ideas. This 
disorder of the thinking, may be consentaneous with the 
perfect health of the emotive or feeling part of our nature. 
The man who cannot recognise the relevancy of the most 
obvious argument, or the agreement or disagreement of 
two of the simplest propositions, may experience no exalta- 
tion or depression of his sentiments ; may act with the same 
integrity, love with the same fervor, and hope and fear as 
intensely as if no change had taken place. Popularly it is 
named confusion of ideas. The diseased process seems to 
consist of the following steps. The mind receives percep- 
tions accurately. The senses convey their reports with the 
customary clearness and fidelity, and. the representations of 
the external world are accordingly exact, and known and 
acted upon as exact. The suggestions of the propensities 
are neither exaggerated nor irregular, and they impel to cer- 

* Perfect's Annals, p. 54. 



WHAT IS INSANITY. 43 

tain actions, become objects of thought and memory, with- 
out any interruption to the laws by which such conditions 
are regulated. But at the point where the mind seeks to 
arrange, contrast, compare, or analyze the ideas thus ac- 
quired, the error which constitutes derangement occurs. 
The qualities which associate or separate ideas are no longer 
appreciable, and reasoning is at an end. For example, vi- 
sion has at some period made an individual acquainted with 
the effects of galvanism upon others, the image conveyed to 
the mind was at the time distinct and correct, and the re- 
collection preserved of it is equally so. At the same, or 
some subsequent period, misfortunes have assailed this per- 
son and produced all the pain of disappointed hopes and 
aggrieved self-love. Now the calamities were real ; the 
melancholy and wounded pride were no more than propor- 
tioned to the circumstances which called them forth, and 
the impressions of these states received and retained were 
true indices of the existing feelings. But when the maniac 
thinks of galvanism, there is probably suggested some por- 
tion of his own distressing history ; he does not and cannot 
see that these events have no possible connexion ; they im- 
mediately become objects of reflection, finding them asso- 
ciated, he believes them to be connected, and the issue may 
be, I shall assume that it is, a conviction that the galvanism 
was the cause of his ruin ; that the contortions which he 
witnessed in the subjects of this experiment, upon which his 
attempt at ratiocination is founded, were proofs that the 
process of destruction was going on in them ; that the un- 
easiness which he experienced on recalling the past is the 
thrilling and tingling sensations communicated by this agent; 
that every man in pain and poverty is galvanized ; that the 
nation is on the eve of bankruptcy, and that galvanism is at 
the bottom of it. The total absence of concord, connexion, 
or sequence in these thoughts, the inability to assort, if such 
a vague expression be admissable, the classes of ideas before 



44" WHAT IS INSANITY. 

the mind according to their qualities and natural order, is 
the principal feature of this form of insanity. The incohe- 
rence of maniacs often depends on this cause; it is that 
plausible incoherence, however, which seems to have a mean- 
ing could it but be discovered. Men so affected may con- 
tinue to mingle with society and to be useful citizens; when 
confined, so much of the mind remains vigorous and sound 
that they may, with perfect prudence, be intrusted with even 
responsible situations in the management. 

But the disease is occasionally more limited in its scope 
than what I have described it. The incapability to perceive 
relations being apparent only when certain classes of ideas 
are presented to the mind, Such is the case of Matthews, 
who imagined that he was the victim of what he learnedly 
called " pneumatic chemistry." By means of this tremen- 
dous agent, mercenary blood-hounds employed to torment 
him, though residing at a distance, introduced notions into 
his brain, intercepted the communication between his brain 
and heart, distended his nerves with gas, and so forth.* Of 
the same kind is the case of the clergyman who believed 
that he had lost his rational soul, refused to join in worship 
as an act of impiety for a being destitute of a spirit, and who, 
in dedicating a book of great merit to the sovereign of the 
time, subscribes himself as one " who was once a man, and 
of some little name, but whose thinking substance wasted for 
seventeen years, and is now utterly come to nothing/'f 
Both of these men retained sufficient intelligence to per- 
ceive the relations of other ideas, or were, to vary the ex- 
pression, rational upon all other subjects. J 

13. Incapability of perceiving the relations of external ob- 
jects. A man cannot divest himself of the belief that the 
house which he has inhabited for years has changed its po- 

* Haslam's Illustrations of Madness. 

T Conolly's Inquiry concerning the Indications of Insanity. 

$ Burrow's Commentaries, p. 299. Guislain, 310. 



WHAT IS INSANITY. 45 

sition, that the windows are diminished or increased in 
number to a frightful extent, that the trees planted by his own 
hands, and firmly rooted and flourishing for years in the 
same spot, move off suddenly in various directions, crowd 
together, or circle round him in the mazes of a dance. He 
hears the most ravishing melody, or the harshest discord 
emanating from every object around ; voices address him, 
and counsel, or threaten him, where there is no tongue to 
speak. But during all this the mind may be very sceptical 
of the reality of the appearances presented to it, and is only 
startled into an unwilling and conditional belief by the diffi- 
culty of answering the question, can 1 doubt the evidence of 
my own senses. But there is more than the senses at fault. 
The powers which take cognizance of their reports must be 
diseased. For we are well assured that, from the nature of 
vision, the retina must receive the picture of the errant house 
as it is, that the actual number of windows must be depicted, 
and that the impressions corresponding to sounds which 
reach the mind do not reach the ear. It is in the combin- 
ing these, the faithful communications of sense, that the in- 
fidelity is committed. The idea of a house maybe well de- 
fined; but the idea of the relation which the house bears to 
the surrounding trees, &c. is vague, indistinct, or erroneous ; 
the idea of windows may be clear, but the interminable mul- 
tiplication of these is the result of the diseased conception of 
that idea. There is no fear, or superstition, consequent on 
such extraordinary visions as that described, the patient 
supposes them to be the real, everyday working of nature, 
and neither looks for, nor detects in them magic, nor divine 
interposition. The delusions of the superstitious maniac 
conjure up objects which do not exist, the present class see 
real objects through a false medium. The individual men- 
tioned may be found to reason sensibly on all subjects ab- 
stracted from external objects, and to act as if his house 
were a fixture, and the trees budded and blossomed in their 



46 WHAT IS INSANITY. 

original soil. The man who saw in his own house the In- 
quisition, and in his chairs the instruments of torture, but 
acted as if he never had heard of St. Dominic or the rack, 
was a complete exemplification of this malady.^ 

14. Incapability of perceiving the qualities of external ob- 
jects. The mind, otherwise unimpa: \m hunting field,. 
for instance, the horses, the dogs., and the sportsmen, i 
gantic or microscopical size : they resemble mammoths or 
ants at full speed : the colouring of the scene is uniform, a 
brilliant scarlet, perhaps, or it is infinitely varied. The in- 
dividual thus affected either cannot perceive the quality of 
an object at all. there is a suspension of the power to do so, 
here no impression is communicated to the mind by 
seven! colours; or the quality is perceived in an imperfect 
and erroneous manner, as when objects appear larger or 
smaller than their actual size : and grotesque shapes occupy 
the place of familiar pieces of furniture.- A great inapti- 
tude is likewise felt to arrange all the visual impressions in- 
to one whole, they start up contrary to the will, in irregular 
succession, and as isolated sensations, so that the hallu- 
cination, besides being a hallucination, is a thing of shreds 
and patches. When this species of madness is accompanied 
by bodily une: tese morbid perceptions are extended 
to the personal condition and feelings of the lunatic, and he 
declares his head to be a lantern, his b:>dy red-hot, or made 
of glass. A royal maniac conceived himself to be a tea-pot. 
believed that he had increased to so enormous a 
size, thai he could not pass out of the door of his apartment, 
and caused the partition to be taken down in consequence. 
I have under my care a sturdy soldier, metamorphosed by 
his own disordered perceptions into a louse ; and Zimmerman 

* E- 7 £= Illusions chez les Alie'nes, passim. 

- Phrenological Journal, voL viii.. p. 44. Phrenological Transac- 
tions, p. 209. 






WHAT IS INSANITY. 47 

mentions a lunatic who, supposing himself a barley-corn, 
was terrified to venture into the open air lest he should be 
picked up by the sparrows.* 

IV. Mania may be defined the irregular action of all the 
mental powers. Its ravages are not confined to certain 
groups of feelings or perceptions, to associations more or 
less extensive, but spread to all. They may not be all 
equally injured ; but so deeply rooted is the perversion as 
to enfeeble that which it does not overthrow. The ideas are 
chaotic, but amid the confusion there may be observed the 
struggle of maddened propensities and extravagant feelings, 
and the jarring of the elements of memory and perception. 
The recollection of some scene long past is mistaken for a 
present impression, there is a want of discrimination between 
what is reflected and what is felt ; the passions are involun- 
tary ; anger bursts forth without provocation ; sorrow arises 
the next moment, terror succeeds without a single cause for 
alarm, and the whole terminates with the loud hollow laugh 
of brutal merriment. There are three things to be consi- 
dered here. First, the want of power to control or direct 
the mental operations. Secondly, the absence of all harmony 
or sequence between these operations. And, thirdly, the 
incessant activity with which these operations are carried on. 
To this last consideration have all the other phenomena been 
referred. In whatever way induced, whether by wine, emo- 
tion, or disease, excessive activity is known to affect the pro- 
pensities and feelings by increasing their excitability and by 
rendering their suggestions intense, irresistible, and involun- 
tary, and, in some cases, if the cause continues to exist, 
permanent. Upon the reflective and perceptive faculties 
the effect of hyperactivity is altogether different. Carried 

* Esquirol, Des Illusions cbez les Alienes, passim. Perfect, 
Annals, p. 333, &c. 



48 WHAT IS INSANITY. 

beyond a certain point, it disturbs, impedes, or arrests the 
healthy operation of the understanding. The excited judg- 
ment may attempt to compare two facts, but the laws under 
which such a step can be made are abrogated. The whole 
of the intellectual powers are simultaneously active, and, in 
place of two, there are twenty propositions to be examined, 
each of these being distorted by the medium through which 
it arrived, and withal, neither the power to exclude what is 
extraneous, nor the power to perceive what is essential to 
the examination, remain. The violent excitement of the 
propensities must materially contribute to this disturbance. 
The process of intoxication amply illustrates the explanation 
given of the psychological cause of mania, the excessive 
simultaneous activity of all the mental powers. The drunk- 
ard, as he swallows repeated draughts of some exciting 
liquor, under its influence waxes valiant, or vain, or gene- 
rous, according to his character. His wrath is fierce, his 
mirth boisterous, his kindness overpowering. Every senti- 
ment is extreme. This is clearly a description of the irre- 
pressible activity of the propensities. Gradually, and in pro- 
portion to the augmenting intensity of the emotions speci- 
fied, the ability to perceive the merits of an opinion is affect- 
ed ; then the perceptive powers fail, and double vision and 
erroneous impressions of all kinds follow. The total con- 
fusion of mania closes the scene. What tends not a little to 
give force to the comparison here instituted, and to shew 
that the states compared are to a certain extent identical, 
differing only in duration, is the great development of phy- 
sical strength and insensibility to pain which occur in both. 
The maniac is in most cases furious as well as incoherent. 
His strength is tremendous, and cannot be restrained or sub- 
dued by ordinary means. It is not, however, necessarily 
exerted for malicious purposes, otherwise death and desola- 
tion must follow his track, and the coercive measures so long 
recommended might appear to be justified. Passive as well 



WHAT IS INSANITY. 49 

as active strength appears to exist in maniacs. Many bruise 
and lacerate their bodies, either with a stoical indifference, or 
with an expression of delight. A sect of insane fanatics at 
one time occupied much attention in France, who endured 
all kinds of torture without a murmur, and among other inge- 
nious contrivances for immolation, they received blows on the 
back, limbs, &c, from sledge-hammers, which, so their histo- 
rians tell, would have crushed a stone wall to powder. These 
symptoms all bespeak increased activity ; but there is also a 
species of mania with diminished activity. Under this de- 
nomination are included cases where the propensities are in 
abeyance or extinct, while the powers purely intellectual are 
diseased with increased activity. The combination of fatui- 
ty of the propensities with incapability of perceiving the re- 
lations of ideas or things will convey a notion of this form of 
disease. There is the same incoherence, preposterous group- 
ing of recollections and actual impressions, as in the preced- 
ing variety, but there is neither wildness, nor vehemence, 
nor irritability, nor terror. The incongruous imaginings 
which the maniac conceives to be opinions, or observations 
on what is presented to his mind, are poured forth volubly, 
but he has neither pride, nor vanity, nor irritability to be 
aroused, either by external or internal impressions.* 

The subject is not exhausted. For these varieties of insanity 
are found in every possible state of combination, exhibiting 
new and characteristic symptoms. Proud monomania may 
thus be found conjoined with that of vanity ; or both these 
states of feeling may exist in the same mind which has been 
deprived of the power to judge of its own operations, or of the 
impressions which it receives from without. But although 
it would require a voluminous treatise on the philosophy of 
insanity to comprehend a description of these combinations, 

* Calmeil de la Paralysie consideree chez les Alit'nes, p. 56, No. 
*r. Art. Folie, Diet, de Med. torn. ix. p. 237. 

D 



50 WHAT IS INSANITY. 

my present object is gained if the sketch here submitted has 
served to indicate the most striking distinctions between the 
different varieties, and how readily and humanely, and pro- 
fitably a separation of the inmates of asylums founded on 
such broad distinctions could be carried into effect 

I have mentioned that until this evening, no attempt has 
been made to address an unprofessional, but well educated 
audience, on the subject of Insanity. Until very recently 
the care of the insane was monopolized by medical and other 
adventurers : a ridiculous stigma, created by the character 
and proceedings of the very persons engaged in this mono- 
poly, deterred regular and well educated practitioners from 
attempting to compete, and even from qualifying themselves 
to do so. Indeed, it has only been since the voice of the 
public has been raised against this monopoly and its conse- 
quences, and the philanthropic of every profession interfered 
in behalf of those who most required their protection, that 
:e and mercy have, in any degree, dictated the treat- 
ment which these unfortunate beings received. Until then, 
a thick and almost impenetrable veil was cast over the work- 
rnind diseased :" a species of awe and sacred- 
m attached to the person of the maniac, as one on 
whom the hand of his Creator had visibly, and fearfully, and 
in a peculiar manner, fallen: the precincts of Lis pri 

x were regarded as holy and peculiar ground, and the 
secrets of that mysterious dwelling remained untold, or only 
whispered in accents of horror and reverence. Eut u the 
day-spring from on high" of knowledge which is beginning 
to diffuse its cheering light on every the most distant land, 
Las visited even the benighted sky of a madhouse, and fallen 
rike healing on the hearts of those, whose doom, in other 
days, must have been imprisonment, solitude, and despair, 



LECTURE II. 



M'HAT ARE THE STATISTICS OF INSANITY? 



The numbers and distribution of Lunatics in Britain — Is insanity in- 
creased by civilization — Does it increase in a greater ratio than the 
population — Does it attack men of particular professions, or of par- 
ticular ranks — Does it prevail chiefly under free, or under despotic- 
forms of Government — What period of life does it principally attack 
— Does Marriage diminish the liability to the Disease — Are Males 01 
Females most exposed — What is the proportion of cures — Rate of 
Mortality — Does Insanity prolong or shorten life — Influence of sea- 
son on Mortality — Diseases affecting Lunatics — Proportion of Fu- 
rious, Paralytic and Epileptic, Fatuous and Idiotic, Dirty, > 
and Suicidal Madmen — Lucid Intervals — Relapses — Complete isola- 
tion — Early confinement — Employment as a means of cure — Propor- 
tion of Lunatics that may be employed — Does it promote the cure? 
— The kind of occupation — Is it safe ? 

What are the statistics of insanity ? What are the num- 
bers, the rank, the occupations, the ages of those who dis- 
play the varieties of disease enumerated, and are committed 
to the care of the physician ; and in what proportion are the y 
susceptible of cure, alleviation or employment? 

In England there are probably not less than 10,000 luna- 
tics ; while in Scotland the numbers are certainly not below 
4000. Of the latter, 1338 are confined in private asylums, 
or licensed houses, unworthy the name of asylum, 21 linger 
out their miserable existence in the jails of some of the re- 
mote counties, 500 are in public establishments, and the 



£2 WHAT ARE THE STATISTICS OF INSANITY. 

remainder, about 1500, are at liberty, subsisting upon cha- 
rity, but in general exposed to the greatest privations.* 

By the calculations of Sir A. Halliday, which, although 
perhaps merely approximations to the truth, have the merit 
of being the only data we possess, it appears that the pro- 
portion of the insane to the sane population of Europe, is I 
to 1000. In Wales the proportion is 1 to 800, in Scotland 
1 to 574. The Americans, so closely allied to us by descent, 
language, national character and customs, it is computed by 
Dr. Brigham, present 1 lunatic in every 262 inhabitants.f 
This disparity probably depends upon the rapid acquisition 
of wealth, and the luxurious social habits to which the good 
fortune of our transatlantic brethren has exposed them. With 
luxury, indeed, insanity appears to keep equal pace. Nay, 
the opinion has been hazarded, that as we recede, step by 
step, from the simple, that is, the savage manners of our an- 
cestors, and advance in industry and knowledge and happi- 
ness,*this malignant persecutor strides onward, signalizing 
every era in the social progress by an increase, a new heca- 
tomb, of victims. Is insanity an inseparable adjunct to 
civilization ? I spurn the supposition. The truth seems to 
be, that the barbarian escapes this scourge because he is 
exempt from many of the physical, and almost all the moral 
sources of mental excitement ; and that the members of 
civilized communities are subjected to it, because the enjoy- 
ments and blessings of augmented power are abused ; because 
the mind is roused to exertion without being disciplined, it is 
stimulated without being strengthened ; because our selfish 
propensities are cultivated while our moral nature is left 
barren, our pleasures becoming poisonous ; and because in 

* A general view of the present state of lunatics and lunatic asylums 
in Great Britain and Ireland, &c, by Sir Andrew Halliday, M.D., pp. 
16 and 27. 

f Remarks on the Influence of Mental Cultivation and Mental ex- 
citement upon health, by A. Brigbam, M.D., p. 52. 



WHAT ARE THE STATISTICS OF INSANITY. 53 

the midst of a blaze of scientific light, and in the presence of 
a thousand temptations to multiply our immediate by a sa- 
crifice of our ultimate gratifications, we remain in the darkest 
ignorance of our own mind, its true relations, its danger and 
its destiny. With civilization then come sudden and agitat- 
ing changes and vicissitudes of fortune ; vicious effeminacy 
of manners; complicated transactions; misdirected views of 
the objects of life ; ambition, and hopes, and fears, which 
man in his primitive state does not and cannot know. But 
these neither constitute, nor are they necessarily connected 
with, civilization. They are defects, obstacles which retard 
the advancement of that amelioration of condition towards 
which every discovery in art, or ethics, must ultimately tend. 
To these defects, and not to the amount of improvement, or 
refinement of a people is insanity to be traced. Statistics, 
the best guide in such an inquiry, support this view. Esqui- 
rol's Tables of the moral causes of insanity clearly show that 
a great majority of these are identical with the vices, pas- 
sions, corruptions, and weaknesses of our nature, or with de- 
viations from what all good or great men understand to be 
the objects of civilization. Few cases can be traced, except 
where hereditary predisposition exists, to the well-regulated 
efforts, the virtuous contentment, or the settled principles of 
a highly educated mind, or to the afHucncp, the enterprise, 
the information, or the polish by which these may be ac- 
companied ; and these, it is conceived, are the legitimate 
products of civilization. And even when a hereditary taint 
creates danger where it would not otherwise exist, it must 
be remembered that it may have been originally contracted 
through the ignorance or error of some individuals, in che- 
rishing some predominating passion, or by intermarriage 
with an impure stock. Vicious as the effect unquestionably 
is of over exertion of the intellectual powers, or of giving an 
undue preponderance to any faculty, and much as the pre- 
vailing systems of education tend to encourage such a prac- 



54 VTBAY ASS THE STATISTICS OF IXSAXITV. 

tiee, I find that out of a total of 47S .irol, 

13 only are referred to an excess of study, while about 100 
are the fruit of the excess of the propensities, and 90 resnk 
from an uneducated and ill regulated state of the sentiments.* 
Georget's lists afford similar evidence. He enumerates 25 
victims of mental labour, 20 of an ill-conducted education, 
106 drunkards, and 470 affected from other moral ca 
out of about 1000 cases.f 

Oneofthe most inte uestions to be decided by 

the statistics of insanity is, does the disease increase, is the 
poisoned stream larger, and wider, and deeper than former- 
ly ? Does it like other streams deepen the channel as it 
flows ? As population is doubled in certain periods, so will 
be the number of cases of disease. But this is not exactly 
the question at issue. Has insanity, like some other dis- 
eases, a greater number of victims in proportion to the po- 
pulation at present existing, than at former periods ? The 
qufttion has been answered in the affirmative. Dr. Powell 
entertains this opinion, and shows that while, in the lustrum be- 
tween 1775 and 1776, the number of registered lunatics was 
17 S3, in that between 1805 and 1809 it amounted to 2271 J 
It must be confessed, however, that his investigations tend 
rather to point out the fallacies which enter into all such cal- 
culations, than to support his own views, or to determine the 
question. Sir A. Haliiday asserts, that the number of lunatics 
has been tripled within the last twenty years : and Esquirol 
plates, that while the patients in the public hospitals in Paris 
in 1801 were only 1070, in 1821 they amounted to 2145. 
These startling facts, on the other hand, have been declared 
to be inconclusive, and those who have adduced them d 
nated alarmists. More careful examination is, without doubt, 

• Diet, des Sciences Med., art- " Folic" Deb Folie. 

J Observations upon the Comparative Prevalence of Insanity at dif- 
ferent Periods. Medical Transactions of the College of Phvsician% 
London, vol. iv. p. 130. 



WHAT ARE THE STATISTICS OF INSANITY. OO 

required to establish the proposition : but this, at least, is 
proved, that a much greater number of cases is known t:> 
exist, and to require treatment, than formerly, whatever 
may be the relative proportion of any given periods. But 
there are many presumptions in favour of Sir A. Halliday's 
opinion. We do not speak of the additional asylums build- 
ing, or recently built, in almost every county in England. 
The majority of those were required and ought to have 
been erected fifty years ago. Nor do I allude to the ac- 
knowledged increase of other nervous diseases: but to the too 
palpable multiplication of the causes which produce mania 
itself. The occupations, amusements, follies, and above all, 
the vices of the present race, are infinitely more favourable 
for the development of the disease then at any previous 
period. We live under the dominion of the propensities 
and must pay the penalty for so doing : and madness is one 
of these. There is one feature which has often struck me 
in examining tables of the causes of insanity in reference to 
the matter under discussion. One half of these is resolvable 
into crime, follies, and ignorance. If we consult Esquirol's 
Table, published in J 835, comprehending 1.557 cases, and 
exclude 337 instances of hereditary taint, as the exciting 
circumstances under which this burst forth are not noted, 
it will appear that 579 are attributable to the excess or 
abuse of the passions, or to the weakness of the uneducated 
intellect.* The writings of the recent statistical authorities, 
Guerry and Quetelet, strongly corroborate this opinion. 
The latter, in quoting from M. Pierquin the observation, 
" Ies crimes sont toujours, par rapport aux populations dans 
une proportion en rapport avec cette de la folie," says, " En 
general je pense effectivement chez lui, que les causes qui 
tendent a produire V alienation mentale, inrluent aussi sur le 
nombre des crimes et sur le nombre des crimes contre les 

* Annales d'Hygiene Publique, Janvier, 1S35. 



56 



WHAT ARE THE STATISTICS OF INSANITY. 



personnes surtout, mais sans qu'il y ait un rapport direct et 
necessaireentrelenombredesfous etcelui des criminels,parce« 
que tous les crimes ne prennent point necessairement leur 
source dans l'alienation mentale."* 

In the table formerly given by this author of the causes 
of alienation, the abuse of intoxicating liquors is scarcely 
mentioned ; in the present 134 are attributed to it.f Are 
these indications of progressive demoralization ? From this 
calculation are excluded 278 cases proceeding from family 
affliction, although in these, vicious dispositions, ill-temper 
or indiscretions must frequently have produced the evils 
from which afflictions arises. In Hoist's tables, the obser- 
vation is still better illustrated. Of 469 cases, the origin of 
which had been ascertained, 323 may be shown to depend 
upon ill-constituted or ill-regulated dispositions.^ 

Such then is the general extent of the malady, upon what 
classes do its ravages fall ? Are there any proscribed or 
privileged orders recognized in the invasion of madness, or 
are there any circumstances over which we possess control 
that appear to promote or prevent that invasion ? There 
are both. And it conveys an impressive truth that the pro- 
fessions which are most intimately connected with temporal 
and selfish interests, and the dispositions which are vicious 
cr lead to vice, are precisely those upon which the infliction 
falls most heavily. It may fall as a punishment ; I must re- 
gard it simply as a consequence, — and believe that certain 
classes of society, and certain courses of life, are exposed to 
insanity, not because they are worldly or wicked, but be- 
cause they expose to excitement and tend to the formation 
of habits of thought and action inimical to the preservation 
of mental serenity and health. Rank, riches, and education, 



* Quetelet, sur l'Homme, p. 126. 
t Diet, des Sciences M^d., Art. " Folic" 

X Official Report of the State of Lunatics in Norway in the year 
1825— quoted in the British and Foreign Medical Review, ISo. I. 



WHAT ARE THE STATISTICS OF INSANITY. 57 

afford no protection against this disease as they do against 
others ; nor do they increase the danger otherwise than by 
giving rise to hopes and fears, and exertions and vicissitudes 
which the humble and illiterate escape. Statistics must de- 
cide this question likewise. And so for as our information 
extends, the privileged orders, to continue this mode of ex- 
pression, are merely those who, from the nature of their 
employments, or their station in life, are farthest removed 
from the causes of the disease. The proscribed orders live in 
and by moral agitation. There is no preservative virtue in 
particular professions, as has been imagined. Mathematical 
study is not an antidote. The science may become as fatal 
a poison to certain intellects as the gaming table or ambi- 
tion. The cultivators of the earth are not so liable to de- 
rangement as the cultivators of the mind itself; but it is not 
because there is anything peculiar or injurious in the latter, 
but because, from accessary circumstances, it is more calcu- 
lated to destroy that tranquillity and equilibrium of the 
powers which is favoured in the former. An eminent wri- 
ter on this subject has made the startling assertion, that 
among the educated classes of patients admitted into Bicette-, 
no instances of insane geometricians, physicians, naturalists, 
or chemists are to be found, while priests, poets, painters, 
and musicians, occur in great numbers.* This can be prov- 
ed to be an error. Bicetre is an asylum for the poor; and, 
from its records, no legitimate conclusions can be drawn as 
to the liability of the educated classes, or professions. Ig- 
norance of the fact may have led to the error; but from 
whatever cause proceeding, the reasoning which has been 
founded upon it, and the obloquy thereby cast on some of the 
noblest pursuits, is triumphantly exposed by a comparison of 
the tables published by different authorities, and especially by 
consulting one given by Esquirol, the most accurate ob- 
server and the most cautious philosopher who has written 

• Conclly. 



58 WHAT ARE THE STATISTICS OF INSANITY. 

upon the subject.* It comprehends 164 cases treated in 
his private asylum, which is appropriated to the wealthy 
and educated, exclusively. Among these we find neither 
priests nor poets. There are, however, two engineers, four 
physicians, four chemists, and several others whose investiga- 
tions had been directed to the observation of the qualities 
and relations of external objects. Although, however, the 
assertion, here combated be inaccurate it is perfectly true 
that priests and poets are more frequently attacked by, or 
are more exposed to, insanity, than either physicians or na- 
turalists. And this for three reasons. First, the study and 
exercise of religion, and the indulgence of the imagination,, 
arouse all our most energetic emotions, keep them in con- 
stant activity, and in this way, tend towards the condition 
most favourable to the appearance of the disease. Second- 
ly, those who from choice adopt and prosecute such sub- 
jects, are naturally and constitutionally more liable to ex- 
citement. And thirdly, the nature of the subjects them- 
selves affords greater provocations to excitement than the 
description of a butterfly, the solution of an arithmetical 
problem, or the diagnosis of a loathsome disease. In speak- 
ing of men of certain professions being naturally more liable 
to excitement, I mean that they are so in consequence of 
the nature of the powers by which they are led to adopt 
these professions, and of the temperament by which these 
powers are influenced. 

If these observations be kept in view, and applied to the 
moral relations and numerical proportions of the remaining 
elements of the same table, the characteristics of the privi- 
leged and proscribed classes, of which we have spoken, may 
be understood. The most numerous classes are, students 
25, military men 33, merchants 50. An ascending series 
indicating the degree of excitement and the source of men- 
tal disturbance to which the members have been subjected, 

* Diet, des Sciences Me'd-, art. " Folie." 



WHAT ARE THE STATISTICS OF INSANITY. 59 

Then follow public functionaries 21, advocates 11, artists 
8, and so on, illustrating the same proposition. The same 
author gives the professions of 500 patients admitted into the 
Asylum at Charenton. Of these 96 belonged to the army, 
63 had been engaged in trade, 60 were proprietors, 31 were 
farmers or gardeners, 15 were students, 6 ecclesiastics, 6 phy- 
sicians, and 2 chemists.* A table in my possession, con- 
taining the admissions to Dr. Duncan's asylum, Ireland, for 
eighteen years, confirms this view.-j- The number amounts 
to 130. Of these, 1 is a schoolmaster, 5 are physicians or 
surgeons, 7 are farmers, 11 are collegians, 11 are lawyers, 
14 are men of property, 14 are clergymen, 29 belong to the 
army or navy, and 37 are merchants, or connected with 
mercantile affairs. 

We do not possess sufficient data to determine the relative 
proportions of the insane rich and the insane poor. The in- 
formation which has been obtained tends to show that the 
former are most numerous. Esquirol and Georget have adopt- 
ed this opinion. At the first stage in the inquiry, it must 
be apparent, that while the poor and the wealthy classes arc 
equally exposed, or rather expose themselves equally, to 
the physical causes; the situation, education and habits of 
the latter are all more favourable to the development of the 
moral causes of insanity, than can be affirmed of the condi- 
tion of the poor. Poverty enjoins a compulsory temperance ; 
it shuts out the longings of ambition ; it acquaints with the 
realities of life, and excludes the effects of sentimentalism ; 
it often trains the body to vigour, and in all these respects 
may be styled prophylactic. The agricultural population, 
which presents poverty in its most attractive forms and en- 
joys its best privileges, is to a great degree exempt from in- 
sanitj'. The returns published by Halliday show, that in 
twelve of the agricultural counties of England, the propor- 

* Annales d' Hygiene Publique, torn. i. p. 119. 
t Statistics of Insanity by Mr. Duncan. Paper read before the 
Royal Medical Society, Edinburgh, 1835. 



60 WHAT ARE THE STATISTICS OP INSANITY. 

tion of lunatics to the whole population is as 1 to 2245, while 
in twelve non-agricultural counties the proportion was 1 to 
1965. Tables given by Esquirol and Duncan establish the 
same relation. The former states the profession in 164 cases, 
only three of these were cultivators of the soil. The latter 
has met with only seven farmers in ISO patients. This ex- 
emption has been explained by a reference to the active ha- 
bits and out-of-door occupations of this class. But this is 
only one cause. The deportment of a great majority of the 
individuals belonging to it is virtuous, their amusements are 
not of an exciting character; they are abstemious, and the 
amount of their wages seldom fluctuates. All these circum- 
stances are favourable to the continuance of sanity. 

Another consideration is equally clear, — the affluent and 
exclusive classes pant after the preservation of caste ; they 
intermarry for this purpose, and thus transmit through an 
endless succession of channels the predisposition to insanity 
wherever it may arise. The state o£ our own peerage amply 
confirms this statement. Hereditary taint is the most fre- 
quent cause of this disease, and it is here established to a 
vast extent in that very position of society which abounds 
with those sources of mental disturbance which are calcu- 
lated to rouse such a taint into activity. The ancient nobi- 
lity of all lands are said to inherit this along with, and in as 
regular succession as, their patents. But it is not to the 
ordeal of the ordinary moral causes alone that the higher 
orders are subjected. Besides wounded pride, jealousy, spe- 
culation, they have to meet, and indeed court, the excitement 
of public affairs. And it needs not to be told that the tem- 
pest of political strife, or civil dissension, which passes over 
the peasant and the artisan unheeded and almost unnoticed, 
shakes and desolates the breasts of those who have honours 
or property to lose or gain, with all its fury. For example, 
the years 1880 and 1831 were marked in Paris for producing 
a greater number of cases of insanity than had occurred dur- 
ing the live previous years. Of the 387 admissions at Charen- 



WHAT ARE THE STATISTICS OP INSANITY. 61 

ton, during these two years, twenty-eight cases were traced 
to political events.* The very great number of Retreats, &c, 
in this country, which are mere speculations, and have been 
intended for the reception of those who can afford to pay for 
such an investment of capital, has been assumed as a good 
reason for believing that the rich are most liable to madness ; 
and, in the absence of better grounds for forming a correct 
judgment, the fact may be interpreted in this manner. From 
the impossibility of obtaining accurate accounts of the state 
of private establishments, and from the fact that vast numbers 
of lunatics are at large, or under the care of their friends, 
nothing more than an approximation to truth can be expected 
from such an inquirjr. A very imperfect mode of estimating 
the respective numbers of the two classes, is by comparing 
the cases admitted into private asylums, where board is paid, 
with those entering public establishments, supported by go- 
vernment or by subscription, within a given period. This 
can be done only in respect to Paris. But as it is a metro- 
polis, having in its bosom all the good and evil of other 
densely inhabited and highly artificial communities, and pre- 
senting nearly the same distribution of property as elsewhere, 
the results of the comparison may be received as evidence 
of the condition of all other places similarly situated. Thus, 
during eight years, from 1804 to 1818, there were 2749 ad- 
missions to Salpetriere, a pauper female asylum. During the 
same period, there were about 1883 admissions to Bieetre, a 
pauper male asylum, making a total of 4632 lunatics sup- 
ported by charity, and, of course, belonging to the most in- 
digent classes. M. Esquirol treated about 300, and M. Du- 
buisson about 240 in three institutions appropriated to the 
rich. Into Charenton, during the eight years from 1826 to 
1S34, 1557 cases were received. t These, with very few ex- 
ceptions, belonged to the better ranks, paying an annual 

* Charenton is a large and excellent asylum in the vicinity of Paris, 
under the superintendence of M. Esqirrol. 
t Burrow's Commentaries, p 512. 



62 WHAT ARE THE STATISTICS OF INSANITY. 

board, varying from £35 to £65. These are not all the pri- 
vate asylums in Paris; but they are all to the records of which 
I have any access. A total of 2090 is thus given. If it be 
borne in mind that the poor generally constitute nine-tenths 
of every community, it must be very evident that the pres- 
sure of the disease falls upon such classes at least as are re- 
moved from absolute poverty. 

Another mode of inquiry may be resorted to. Several 
years ago, and before the erection of Haawell, it was com- 
puted that there were residing in confinement in and around 
London the enormous number of 7000 lunatics. Now, sup- 
posing each of the large public asylums capable of containing 
500, which they are not; and supposing further that the de- 
pendencies at Hoxton, Bethnal Green, &c. contained another 
thousand, or even fifteen hundred, there will still remain4500 
who cannot be ranked with paupers, and accordingly must 
be concluded to pay for their maintenance, and in a great 
majority of instances to belong to the wealthier classes. 

Leveille has recorded a very curious observation on this 
subject. In examining the French hospitals in 1803, he 
found that, of the lunatics rendered insane by the events of 
the revolution, the males belonged to the aristocracy, the 
females to the democracy. Disappointed and successful am- 
bition had thus produced a similar result; and that equality 
which pulled the one down, and raised the other up, had 
proved fatal in the same way.* 

Esquirol supposes that the rich are less exposed to relapses 
than the poor, as they have it in their power to distract and 
give tone to the mind, and to avoid the exciting causes. 

The assertion of the greater prevalence of mental disease 
under free than under despotic forms of government, may be 
treated in the same spirit as that displayed in examining the 
alleged connexion of insanity with civilization. I admit the 

* Rapport fait au Conseil General des Hospices par un de ses mem- 
bres, sur l'etat des Hopitaux des Hospices, &c, depuis le l er Janvier, 
1.804, jusqu'au l er Janvier, 1814.. Paris, 1816. 



^■M 



WHAT ARE THE STATISTICS OF INSANITY. 63 

fact, but deny the inference. Tyranny has no protective in- t 
fluence — liberty is not the foe of mental health. Consump- 
tion has doubled its ravages since the use of tea prevailed, 
and cholera has invaded the country since the passing of the 
Reform Bill; and these facts have nearly the same connex- 
ion that the prevalence of insanity has with the nature of the 
constitution under which a people lives. But although the 
form of government which, it will be observed, is generally 
the result and representation, and not the cause of the exist- 
ing state of feeling, exercises no influence in the production 
of insanity, the mode in which it is administered, the social 
relations, the tranquillity or the fluctuations in the habits, 
value of property and rank, the degree of prosperity, and the 
moral and religious condition which arise out of it, must ob- 
viously do so. In that state, then, be it monarchical or repub- 
lican, in which the sources of moral agitation and excitement 
are most abundant, will the proportion of insanity be the highest. 
Panics in the commercial classes, civil commotions, war, 
rapid influx and reflux of wealth, and ambitious projects, 
which are the most fertile and frequent moral causes of the 
disease, may occur, and have occurred, under every form of 
government, and affect mankind, not because they are slaves 
or citizens, but because their bodies are weak and vitiated, 
their minds excitable and ill-balanced. A state in which 
wide-spreading changes did not and could not take place, 
would afford, to a certain and great extent, a guarantee against 
madness. Were despotism another word for tranquillity, and 
freedom for turmoil, the line of exemption would be clearly 
defined. But public order and disorganization, although 
undoubtedly favoured by political relations, flow more from 
the character than the actual condition of a people, and ac- 
cordingly affect indiscriminately the bond and the free. Thus 
the free American is comparatively more liable to derange- 
ment than the free Swiss ; — cretinism is, of course, excluded 
from the comparison. The enslaved Turk is exempt; the 
conquered Hindoo liable. The act of liberation, however, is 



64 WHAT ARE THE STATISTICS OF INSANITY. 

certainly inimical to mental peace. It operates, like all other 
great political movements, by powerfully affecting the inte- 
rests of the mass, by calling forth the deepest sympathies, the 
most ungovernable passions of the human breast. The French 
Revolution is said to have filled the asylums to overflowing. 
The immediate effects of the Crusades, the Reformation, and 
the retreat from Moscow, were similar. These statements, 
from the remoteness or the peculiar character of the periods 
to which they refer, are necessarily vague and unsupported 
by proof. But on turning to the Irish rebellion, the traces 
and history of which are still fresh and before us, we find from 
Kalloran that of 693 cases, 108, or nearly one-seventh, were 
produced by the terror, the hostility, and the hopes then pre- 
vailing.* From Esquirol we learn that of 492 cases, forty- 
five resulted from public events; and that of the same num- 
ber, ninety-one were occasioned by reverse of fortune, an 
event often dependent on the current of political affairs, and 
ranking next to them in its detrimental influence on the 
mind. Georget shews that of 1079 cases, 116 were attribut- 
able to political changes, and that these are among the most 
fertile of the moral causes. This is not the general opinion, 
nor is it countenanced by experience. Esquirol's observa- 
tions., we have said, go to shew that while of 492 cases, only 
forty-five could be traced to popular commotion, not less than 
136 were caused by domestic affliction, and the enormous 
number of 178 originated in the predominance, or non- 
gratification of such passions as self-love, ambition, anger, 
jealousy, and sensual desire. This is as good a commentary, 
and probably contains a more impressive lesson on the ne- 
cessity for a virtuous and well-regulated mind, than a homily, 
or a treatise on ethics. 

The number of lunatics is said to be much greater in America 
than in any European country. Can this be the effect, it has 
been asked, of the acquisition of independence, or of the opera- 
tion of the constitution under which the people live ? I am 

* BalToran on the Causes and Cure of Insanity- 



WHAT ARE THE STATISTICS OF INSANITY. 65 

disposed to believe that a concurrence of causes may have 
produced this result. First, the abuse of ardent spirits, and 
especially dram-drinking, is reported to prevail to an awful 
and destructive extent. Secondly, money is gained easily 
and rapidly, and the abject and tiie ignorant become sudden- 
ly rich, without becoming better or wiser ; the means of en- 
joyment thus increase more quickly than the means of moral 
training, and there are the effects of unexpected prosperity, 
and the gross and unrestrained gratifications of an ill-regu- 
lated mind to contend with. Thirdly, without wishing to 
repeat the heartless sneer that the Adam and Eve of the 
United States were born in Newgate, the fact cannot be 
overlooked that the sources of the tide of population, which 
has been flowing for so many years uninterruptedly towards 
America, have been impure and poisoned. The refuse of 
other nations has been poured forth. I do not wish to speak 
disparagingly, nor do I allude merely to the criminal out- 
casts of the old communities, but to the ruined, the unfor- 
tunate, the disappointed, the adventurous, all those, in fact, 
whose minds are predisposed by previous circumstances to 
excitement and disease. Fourthly, the intensencss of politi- 
cal feeling, and the agitating nature of the civil contests in 
which the inhabitants generally are from time to time engaged, 
must decidedly contribute to the development of the disease. 
The most useful and active period of life is that most ex- 
posed to the incursion of mania. Its activity is the cause. 
All the mental energies are then excited, the affections find 
objects, the passions are roused, and if there be a weak or 
imperfect part of our nature, it is then shaken and may be 
cast down in the struggle for subsistence, or wealth, or pow- 
er ; or by the anxieties which will arise in the even tenor of 
the most humble and unambitious career. Sources of dis- 
quietude, altogether unconnected with the constitution of the 
mind, are then most abundant. Man emerges from the moral 
nonage of youth into the awful responsibility of indepen- 



65 WHAT ARE THE STATISTICS OF INSANITT. 

dence, and new scenes, new situations, new feelings are the 
consequence: and changes, and misfortunes, and sorrow, in- 
evitably come. If the mind has been originally vigorous and 
consolidated by a good education it withstands the shock, 
but if there exists a hereditary predisposition or debility, a 
proneness to excitement, an exalted state of feelings at the 
expence of the intellect, that is, the absence of a well adjust- 
ed balance between the emotive and reflective powers, it 
totters and falls. The body is, at the same time, more sub- 
jected to the physical causes of the malady. The accidents 
of an active profession, the pernicious customs of society, the 
diseases of mature age, all come into operation, and contri- 
bute to swell the amount of attacks in adults. Extensive 
observation shews that the greatest number of cases of 
lunacy occur between thirty and forty. No age is exempt, 
for even infants and octogenarians become insane : but the 
frequency of the disease during the deeade mentioned is 
evinced by the fact that of 2507, 572, or more than one-fifth, 
occurred within its limits. Nearly the same proportion is 
observed in Hoist's tables, where, of 1909 lunatics, 887 became 
deranged between thirty and forty. If it be recollected that 
not only is society liable to be deprived of the services of its 
citizens at the precise moment when they are most valuable, 
but that at this period a vast proportion of the population of 
a country become parents, and transmit to their lineage what- 
ever is good or evil, strong or weak in themselves: a still 
more urgent reason is perceived, were the awful character 
of the disease itself insufficient for guarding against the attack, 
and for providing means the most ample and adequate for the 
removal of the disease. The fact is worth recording, and is 
connected with this part of the subject, that marriage, and the 
peace and happiness which it secures, afford a protection from 
insanity. This conclusion cannot, at least, be held to be un- 
justifiable, or the grounds from which it is drawn accidental, 
when in tables framed in various countries the unmarried or 



WHAT ARE THE STATISTICS OF INSANITY. 67 

widowed lunatics always preponderate. Two tables shew 
the following relations. The first refers to the admissions at 
Charenton.* 

Unmarried or widowed 859 

Married 698 

Difference 161 

The second is extracted from Mr. Duncan's manuscript Es- 
say on the Statistics of Insanity. He does not mention his 
authority. 

Unmarried 1779 

Married 578 

Difference 1201 

Marriage may diminish the tendency to mental alienation 
in various ways, either by removing individuals from the in- 
fluence of many of the exciting causes, or by the formation 
of regular habits, and the cultivation of virtuous impulses, 
rendering that influence innocuous. To woman it generally 
is or ought to be the point towards which all her wishes have 
formerly converged, and from which all her future hopes and 
happiness are to emanate. To man it is the shield against 
himself and his passions ; he seeks and finds in it joy, solace, 
and support, when his own thoughts, avocations, or the world 
fail to furnish either. If founded on harmony of disposition, 
not only does it create the capabilities of enjoyment, but of 
enduring pain ; and on this account, and because it neutral- 
izes selfish feelings and pleasures, because it prevents the 
mind from retiring on itself, acts as a barrier against hidden 
sorrows, gives employment to our noblest qualities, and while 
chequered by the ordinary vicissitudes of life, because it 
yields no strong or sudden or permanent excitement, it is an 
antidote to insanity. 

Of the parties to this engagement females are perhaps most 
* Annales d' Hygiene Publique. Janvier, 1835. 



68 



WHAT ARE THE STATISTICS OF INSANITY. 



subject to insanity, both before and after its consummation. 
This has been attributed to the peculiarities of their consti- 
tution, the delicacy of frame and susceptibility of mind by 
which the sex is distinguished. That these act powerfully 
in producing insanity cannot be questioned. But if this set 
of causes be confined in their operation to women, so are a 
large proportion of the physical causes and the influence of 
ambition, speculation, and dissipation, confined in their ope- 
ration to men ; so that upon these grounds no explanation of 
the inequality can be received or attempted. The education 
of females is, however, more imperfect and vicious than that 
of men ; it tends to arrest the development of the body ; it 
overtasks certain mental powers, it leaves others untouched 
and untaught ; so far as it is moral it is directed to sordid and 
selfish feelings, and substitutes a vapid sentimentalism for a 
knowledge of the realities and duties of life. From such a 
perversion of the means of training, what can be expected to 
flow but sickly refinement, weak insipidity, or absolute dis- 
ease. That which is intended to impart, and is incapable of 
imparting strength and stability, becomes the source of de- 
bility and decay; that which is created as a bulwark of de- 
fence, is converted into the open and easy road by which the 
enemy may enter. Before any reasoning on this point can 
be considered definitive, it will be necessary to know the pro- 
portion of the causes affecting the two sexes. This depart- 
ment of statistics is still uncultivated, almost unknown. 

The facts are as follow : in one table of lunatics, Duncan's, 
there are 752 males, 1625 females: in another of 2507 in- 
sane in the Parisian hospitals, 1095 are men, 1412 women. 
This great disparity is not uniformly observed in France or 
even in Paris, but from the moral condition of that country 
it would not have excited our surprise had it been so. For 
example, one-twentieth of the patients at Saltpetriere are sup- 
posed to be insane from prostitution.* Esquirol has calcu- 
* Esquirol — Parent Duchatelet. Dela Prostitution dans la Vine de Paris. 



WHAT ARE THE STATISTICS OF INSANITY. 69 

lated that of 25,083 persons ascertained to be insane in 
France, 1 1,119 are males, 13,964 females. In Milan the num- 
bers are 2699 men, 3207 women. Some other countries 
present an equal proportion of lunatics in both sexes. In 
Norway there appears to be a greater number of male than 
female lunatics.* Scotland, in 1818, had 2311 men and 
3339 women insane. In some other instances the males are 
most numerous ; but a general census would, it is believed, 
substantiate the view given above. 

Medical men long acted as if nothing could be done with 
any chance of success in insanity. They believed that were 
the bowels regulated and the organic functions attended to, 
their duty was discharged, and the vaunted powers of medi- 
cine sufficiently vindicated. The suspicion even arose that 
the disease could not be removed, that it did not come under 
the ordinary rules of art. Drs. Munro, Burrows, and Ellis, 
declare, however, that they cure ninety out of every hun- 
dred cases. Such a result proves, so far as the practice of 
these observers is concerned, that instead of being the most 
intractable it is the most curable of all diseases. The declar- 
ation, however, applies only to recent cases, which have not 
existed for more than three months, and which have been 
treated under the most favourable circumstances ; as the pa- 
tients either belonged to the independent classes or were in- 
mates of one of the most deservedly celebrated institutions in 
England, Wakefield, under the care of one of the most en- 
lightened physicians in Europe. But even where poverty, 
popular prejudice, indifference, or other obstacles, have de- 
prived the insane of many of those means which it is in the 
power of benevolence and art to bestow, the proportion of 
cures issuch as to dispel the disheartening and unworthy con- 
viction that this affliction must continue to baffle human skill* 



Quetelet sur l'Horame, tome ii. p. 127. 



70 WHAT ARE THE STATISTICS OF INSANITY. 

and to open up a vista of delightful anticipations of what 
might be effected by a coalition between the philanthropists 
and the philosophers. That proportion, be it observed, in- 
variably corresponds to the degree in which the treatment is 
in unison with the laws of the human mind. It does not de- 
pend upon, or vary with, local circumstances; it is the same 
in Italy as in England ; it bears little relation to the occupa- 
tion, sex, or age of the patient, and less to the cause of the 
malady, unless that be organic ; it cannot even be attributed 
to the talents of the physician, save where these are dedicat- 
ed solemnly and enthusiastically to the task, and made the 
instruments by which it is to be accomplished. If all asy- 
lums had advanced to that stage of improvement to which 
they will ultimately be forced by the irresistible impetus of 
public opinion ; and were patients placed under treatment on 
the very first and slightest indication, the oddity or eccen- 
tricity which ushers in the disease, I have no hesitation in 
affirming, that the proportion given by Ellis would become 
universal. Even now, contending, as physicians to the in- 
sane have almost everjavhere to do, with errors and difficul- 
ties which none can appreciate save those who have tried to 
put the moral machinery of an asylum into operation ; and 
taking all cases as they are presented, of long or short dura- 
tion, simple or complicated with malformation of thchead or or- 
ganicdisease, the average number cured isabout one-half. Put 
out of view the drawbacks mentioned, and consider only the 
numbers cured of other diseases, cast up the recoveries from 
consumption which is said to destroy all its victims, from 
cholera which destroys one half, from pneumonia which de- 
stroys about irbejity- nine per cent., or from less fatal ailments; 
and having found that not two-thirds escape at all, and not 
one-twentieth without some injury to the constitution, which 
embitters, if it do not shorten life ; and the vast benefit con- 
ferred on society by that treatment of the insane will be per- 
ceived, which restores to the affections of their friends, and 



WHAT ARE THE STATISTICS OF INSANITY* 71 

the duties of active life, and the glorious prerogative of serv- 
ing God with the eye of reason clear, and the pulse of feel- 
ing calm, one half of those who would otherwise be lost to 
themselves and to the world, and lapse into fury or loathsome 
futurity. We will here introduce a table of the proportions 
recovered in different establishments. 

Number of years 

on which the aver- Hospital. Proportion of cures, 

age is taken. 

25 Senavra, Milan 58 in 100 3 

2 Charenton, Paris 40... — b 

12 Salpetritre and Bicetre 34 ... — c 

12 Ivry, Paris 51... — d 

13 Retreat, York 50 ... — e 

16 Lancaster 40... — f 

8 Gloucester 48 ... — s 

York, (county asylum). .49 ... — h 

5 Bethlem, 1748-1794 28 J 

1 Bethlem, 1813 49... — . i 

15 Bethlem, 1819-1833 50 ... — * 

5 Wakefield 42 - l 

10 Stafford 43... — m 

2 Dundee 50... — " 

5 Perth 46 ... — ° 

Hartford, United States 91 j% — p 

This table has been constructed and is given to the public 
merely to convey some idea of what has been effected under 

a Burrow's Commentaries, p. 522. b Diet, des Sciences Med. 

art. "Folie." c Ibid. d Ibid. e Pritchard's Treatise 

on Insanity. f Ibid. e Ibid. h Ibid, and Esquirol, Mem. 

de l'Acad. Roy. de Med. > Ibid. 1 Ibid. k Ibid. ! Burrows. 
m Ibid. h Annual Reports of Dundee. ° Annual Reports 

of Murray's Asylum, Perth. v Combe on Mental Derangement, 

p. 923. 



72 WHAT ARE THS STATISTICS OF INSANITY. 

different circumstances, but has no pretensions either to rigid 
exactitude or to be considered as affording a complete view 
of the subject. The calculations proceeded on the number 
of admissions and cures annually, and not upon the actual 
number of patients in the asylums at one, or within any given 
period. 

The success at Hartford, which is probably the most per- 
fect example of an asylum conducted on sound principles, is 
highly encouraging. The proportion is exactly that which 
Ellis and Burrows have met with in recent cases and in pri- 
vate practice, and affords the most irrefragable proof of how 
much may be accomplished by employing all the means 
within our reach. The table now given refers chiefly to the 
results of the current century. No one conversant with the 
details of the subject can doubt that the proportion of cures 
corresponds to the improvement of each establishment, and 
that the gross amount of cures is much greater within the 
last twenty years than during any previous period of the same 
length, that is, since the recognition of humanity and em- 
ployment as means of treatment. In the foregoing synopsis 
those only are included whose reason was completely re-es- 
tablished. But there are two other classes not noticed which 
swell the amount of good: those who, retaining some visi- 
onary project or harmless delusion, are dismissed so materi- 
ally improved as to be capable of engaging in the pursuits 
and tasting the pleasures of life, with great additional happi- 
ness to themselves and perfect safety to others : and, second- 
ly, those who. although requiring to be protected from them- 
selves and displaying some untameable appetite which would 
render liberty a curse, pass, under proper guidance, long in- 
tervals of contentment, who are soothed: when unruly, cheer- 
ed when depressed, advised when capricious, and are at all 
times and in every mood surrounded by friends. 

Mental disease has been imagined to confer longevity. 
To bolster up this imagination, for it is nothing more, in- 



WHAT ARE THE STATISTICS OF INSANITY. 73 

stances have been cited of lunatics reaching a great age : the 
same thing has been said and done with respect to gout, but 
without weakening the principle that any serious structural 
change, or impairment of function, renders the system more 
susceptible of disease, and less able to resist its effects. It 
would be matter for regret, were it true, that life was pro- 
longed by such means ; but the truth is that life is shortened. 
To understand this statement, it ought to be premised, that 
it is not my intention to assert that disorder of reason, which 
is merely a symptom, shortens life, but that the affections of 
the nervous system, upon which it depends, tend to do so. In 
this sense it is no paradox to say that no one ever dies of in- 
sanity. The bills of mortality announce the contrary ; but 
it is well known that these are utterly worthless as scientific 
documents, and that they are the compilation of churchwar- 
dens and old women.* The bill for 1834 has the absurd 
calculation that 170 persons died from this disease.f The 
meaning of this, or the interpretation which a medical man 
acquainted with the subject would give to it, is, that 171) 
persons died while insane. But if you proceed to examine the 
reports of the asylums in which these 170 were confined, or 
even listen to the descriptions of their friends, you will dis- 
cover that they suffered and succumbed under consumption, 
dropsy, or more frequently apoplexy, epilepsy, or some other 
malady of definite character, to which all men are liable. 
All those who have actually practised among the insane, 
know, and have cause to grieve, that besides derangement, 
they are required to treat disease in all its forms. There are 
then two evils to be combated, and hence arises the greater 
mortality of the insane. There is the irritation, or organic 
change, existing in the centre of the nervous system, the 
cause of the insanity, lessening the general tone of the sys- 
tem, and producing great disturbance as a secondary conse- 

* Blizard. Remarks on Public Hospitals, p. 71. 
t Companion to the Almanac, p. 37. 1836. 

E 



74 WHAT ARE THE STATISTICS OF INSANITY/ 

quence, and there is some other affection rendered more 
intense and more intractable from that lessened tone and 
general disturbance. But if the presence of the cause of in- 
sanity militates so much against the restorative efforts of na- 
ture and the remedial means employed, may it not predispose 
to disease, and promote the frequency of its incursion as well 
a&its violence. I believe that it may. That it directly induces 
apoplexy, ramolissement, congestion, and so forth, there is 
not the slightest doubt; and there is every probability that 
it influences the condition of organs remote from, although, 
of course, not independent of the nervous system, But 
other considerations are mixed up with this question. In 
General the situation of lunatics is unfavourable for the resis- 
tance of disease. The confession of a person intrusted with 
two private asylums, that from want of suitable protection- 
from the weather, nourishing diet, cleanliness, &c. a hundred 
of his patients perished in one season from typhus fever, will 
explain the meaning of this observation."" Even when no 
such maladministration exists, the patients in asylums often 
take little exercise, — they are allowed to eat immoderately, 
— their habits are uncleanly,— they pass their days in close 
heated rooms, and their nights in rooms equally close, but of 
a low temperature ; they are, in short, placed under enervat- 
ing and depressing circumstances. Again, when attacked by 
disease, unless the symptoms be of such a nature as to come 
within reach of the senses, or of those modes of exploration 
which are intended to aid or correct the senses, the powers 
of medicine are, in a great number of cases, sadly trammelled. 
All the information derivable from the patient's own sensa- 
tions is denied ; for he may undervalue or exaggerate the pain 
which he suffers, or he may refer it to a healthy region : the 
origin and progress of the disease remain a blank from his 
inability or unwillingness to disclose them. The duty of a 

* First Report of Minutes of Evidence from Committee on Mad- 
houses, 1816, p. 9. 



WHAT ARE THE STATISTICS OF INSANITY. 75 

physician is, in such a situation, a very painful one : he sees 
a fellow-creature writhing in agony, which may be that of a 
troubled spirit or result from bodily suffering : he sees the 
ravages of a deep-seated malady, but the exact seat of which 
he can at best only conjecture : he hears supplications for aid 
which he cannot afford : he is obliged to grope his way in 
the darkness of empiricism, altering the direction of his steps 
every hour, and at last finds that all his efforts have not only 
been vain, but injurious. Such situations cannot always be 
avoided ; but the frequency of their occurrence may be les- 
sened by increasing the chances of recovery among the in- 
sane, and by placing them in circumstances more conducive 
to health. The rate of mortality will vary somewhat in dif- 
ferent asylums according to the locality, the classes admitted, 
and the treatment pursued ; but the following table may be 
presented, as exhibiting these differences, and their influence. 
There die in 

Wakefield Asylum, 24 in 100 patients, or lin4 

Lancaster, 24^ 1 ... 4 

French Hospitals, 22 1...4£ 

Senaora, Italy, 42^ 1...2J 

Cork, 30 1...3J 

Retreat, at York, 20 1...5 

Charenton, 25 1...4 

Glasgow, .10 1.10 

Burrow's Private Asylum, ... 6^ 1 ..1 5 

Now, if these statements be compared with the results of 
the practice in any common hospitals, the proposition which 
has been advanced will be readily admitted. From the re- 
ports of eight of the principal hospitals in London, it appears 
that the deaths per cent, of all patients received, vary from 
seven to ten, while in ten provincial institutions, the mortal- 
ity ranges from three to seven per cent.* In the Hotel 

• British Medical Almanack, 1836. 



76 WHAT ARE THE STATISTICS OF INSANITY. 

Dieu at Paris, the deaths amount to seven per cent ; and in 
La Charite at Berlin alone, of all the continental hospitals to 
the statistics of which we have access, do they reach so high 
as 25 per cent. 

By far the most fatal seasons to lunatics are autumn and 
winter. A fact which shews the necessity, should humanity 
require the lesson, of protecting them effectually against the 
influence of the atmosphere and its sudden alternations. Of 
798 deaths at Salpetriere, 175 took place during the spring, 
and 174 during the summer quarter, while in autumn there 
occurred 234, and in winter 207. At Charenton the dis- 
parity is equally marked ; 119 deaths took' place in summer, 
160 in winter. 

The diseases which destroy lunatics afford cumulative evi- 
dence of the positions that the mortality among them is great, 
and that it is affected by the nature of the circumstances in 
which they are placed. We learn from a table, embracing 
nearly 3G0 cases, that the diseases most prevalent among 
lunatics, attack them in the following order, — colliquative 
diarrhoea, scurvy, affections of the liver, apoplexy, typhoid 
fevers, nervous tevers, phthisis. With two exceptions, these 
are the results of debility. In another table, including 995 
deaths, which took place in a number of the principal asy- 
lums in England, the proportions from the following diseases 
are, exhaustion and old age, 227 ; apoplexy and paralysis, 
152 ; diarrhoea and dysentery, 132 ; consumption, 119 ; epi- 
lepsy and convulsions, 104.* Apart from the affections of 
the chest, abdomen, and fibrous tissues, directly produced 
by changes of temperature, the cold of winter has a depress- 
ing effect upon the system, which indirectly causes ulcers on 
the legs, loss of motion, and when the clothing is inadequate, 
frost- biting. 

Besides being distributed into the curable and incurable, 

* Parliamentary Returns from County Asylums, 1836. 



WHAT ARE THE STATISTICS OF INSANITY. 77 

the inmates of an asylum are subdivided into other groups, 
the precise numbers of which it is of some importance to as- 
certain, in order to make arrangements suited to their respec- 
tive wants and habits. The sections of the curable are very- 
obvious, and are considered elsewhere. The incurable may 
be arranged into various classes. There is, first, the furious 
madman, thirsting for blood, glorying in the destruction oi 
every thing around, and requiring, for his self-preservation, 
and the enjoyment of those transitory throbs of happiness of 
which his soul is still susceptible, to be coerced, leniently, 
and as rarely as possible, but to be completely deprived of 
the power of doing injury. Such cases do certainly occur, 
although not so frequently, nor of such a frightfully irre- 
claimable nature as the supporters of the old system would 
have us to believe.* Were we to be guided by a work which 
appeared about twenty years ago, our conclusions would be 
widely different.f From this source we learn, that of 1649 
maniacs admitted in Bedlam, 743 were mischievous, and 20 
had committed murder. There are only three ways of recon- 
ciling the discrepancy thus created with the experience of 
recent observers. Either the inmates of Bedlam must at that 
time have been chosen on the ground of their turbulence or 
treachery ; or an epidemic of mischief must have lurked 
within its walls ; or, lastly, our national character must have 
undergone a change. Whatever alternative we may adopt, 
the change itself is matter for congratulation. Tor now the 
largest establishments boast of having only one or two irre- 
claimable patients, and of having discarded strait-waist- 
coats as well as stripes. There is clearly a homicidal and 
destructive mania, in which no kindness, no moral tie what- 
ever, avails aught in preventing the sacrifice of life and pro- 
perty. You will hear of institutions conducted upon princi- 
ples of freedom and humanity, where there are neither chains 

* Brierre de Boismont, Annales d' Hygiene, Juillet 1836, p. 56. 
f Black's Dissertation on Insanity. 



78 WHAT ARE THE STATISTICS OF INSANITY. 

nor chastisement ; but even under such mild government as 
this, the furious maniac will be furious still, strew death and 
desolation around, immolate his friends and protectors, and 
exult in his deeds of vengeance. The boast of the reformed 
treatment is, that these unfortunate beings are at once de- 
tected, that no one is restrained on suspicion, that the periods 
of exacerbation are known and provided for, that the precau- 
tions adopted are compatible with many pleasures, and often 
with the personal liberty of the patient. The proportion of 
such a dangerous species of derangement is not well known : 
indeed it must vary with the country, the race, class and oc- 
cupation of the individuals diseased ; but it is estimated, that 
of a hundred admissions not more than three will remain, un- 
der proper management, permanently and immitigably fu- 
rious.* The number of furious, or rather unmanageable 
females, is greater than that of males. 

Nor is such an inquiry unimportant for practical purposes. 
Formerly asylums were constructed upon the principle that 
ninety-five required to be restrained, that five only could be 
intrusted with freedom. The considerations submitted above 
shew, that now arrangements must be made in order to afford 
freedom to the ninety-five, and adequate restraint to the five. 

The second group is that of the paralytic and epileptic 
incurables. They probably amount to one-tenth of the 
whole. Hoist states that of 1422 cases, 245 were epileptics. 
From the tables of Leveille we learn, that of 3662 cases ad- 
mitted at Bicetre, 1292 were epileptics, that is, nearly one- 
third of the whole. The proportion is not so large in this 
country. Of 734 deaths which occurred in nine of the prin- 
cipal county asylums in England, 104, or one-seventh, were 
from epilepsy. The demands of this class on the affectionate 
care of those around are constant and imperative. There is 
the helplessness, without the hopes of childhood, to excite 

* First Report from Committee on Madhouses, p. 51. 



WHAT ARE THE STATISTICS OF INSANITY. 79 

pity. Instead of expanding, their minds contract under your 
care; their wants diminish, and are at last reduced to the 
desire for food, and a claim upon some friendly arm to sup- 
port their tottering steps. 

The third is a very numerous class. The imbecile, fatu- 
ous, and idiotic constitute in this and some other countries 
more than one-fifth of all the cases submitted to treatment. 
In Norway, however, they are more than one-half, the num- 
bers being 682 to 1229. Although placed beyond the reach 
of all alleviation from medicine, this form of alienation ad- 
mits of great alleviation from external circumstances. These 
individuals have many joys, and the circle may be greatly 
widened. They may be roused to exertion and industry ! 
some last lingering gleam of intelligence may be brought to 
bear on the pleasing parts of their condition — some half-ex- 
tinguished habit may be encouraged ; the power of tasting 
the physical enjoyments of existence may be gratified in such 
a manner that their life may be passed in a succession of 
useful employments and agreeable sensations. This is, more 
than all besides, the boast of modern physicians. If they 
cannot cure the imbecile and fatuous, they can render them 
happy. 

There is a fourth group. It brings us in contact with the 
humiliating spectacle of the body living and breathing, but 
no longer animated by the slightest spark of reason, where 
even the senses are benumbed or annihilated, and, saving the 
human form, man becomes as the clod of the valley. In this 
situation patients are insensible to the calls of nature, and 
put to a severe test the kindness and forbearance of those to 
whom they are intrusted. A practical man has estimated 
that of every hundred lunatics, there are ten who have lost 
all power over the sphincter muscles. But this is probably 
erroneous. The same authority calculates that every third 
lunatic, whether curable or not, contracts dirty habits. I 
believe that this is likewise an exaggerated estimate. To 



80 WHAT ARE THE STATISTICS OF INSANITY. 

those who are accustomed to regard with pride the charac- 
teristic cleanliness of a portion, at least, of our countrymen, 
but have not traced this quality to a national mental consti- 
tution, such a statement will appear ridiculous. But the love 
of order and neatness share in the common ruin, and may be 
extinguished, as well as the love of wealth or of friends, and 
the consequence is, although not to the extent, of the kind 
described. The slovenliness, the loathsome and disgusting 
peculiarities, and utter disregard to decency or propriety 
which follow in the train of madness, are astonishing, almost 
incredible. The state of abstraction in which many indivi- 
duals are plunged, and their corporeal weakness, contribute 
as much as the disease of the perceptive powers, to this re- 
sult. With proper care, however, and training — for the in- 
sane must be taught their habits anew — this evil may be 
greatly modified, and in one-half of the cases where it appears 
altogether eradicated. There are some cases where, from a 
wish to offend the delicacy of others, or from absolutely glory- 
ing in shame, no persuasion or precaution can prevent the 
insane from going about in a state of nudity. Clothe them 
twenty times a-day, and twenty times will they appear naked. 
This generally takes place where lunacy has been engrafted 
on vicious and abandoned habits. Some restraint must be 
resorted to, but fortunately incurable cases of this kind do not 
occur oftenerthan 1 in 100. Occasionally idiots and epilep- 
tics strip themselves from no worse motive than idleness, or 
to enjoy a cold air bath. 

In every hundred patients there will be five noisy ones : 
riotous, not from the desperation of anger or fear, but from 
the truly Irish love of fun and mischief, or from irrepressible 
garrulity, which is itself a form of madness. This feature, ac- 
cording to Guislain, presents itself in every ninth lunatic* 
Such inmates may be easily tolerated, and soothed into quiet- 

* Sur les Phrenopathies, p. 199. 



WHAT ARE THE STATISTICS OF INSANITY. 81 

ness during the day, but during the night their cries and lo- 
quacity, for they are sleepless, are altogether inconsistent 
with that stillness which to the troubled mind is the best 
anodyne I know of. Every patient is thus aroused — the fu- 
rious maddened, the desponding and timid horrified ; and the 
hours of rest become hours of turmoil and excitement. To 
meet such a state of things, a part of every asylum should 
be deafened ; and so effectually deafened, that all who are 
able to obtain sleep may do so undisturbed. Or what is still 
better, the noisy and refractory should inhabit distinct build- 
ings. Then their melancholy orgies may proceed without 
interruption. 

With the furious may be classed those who are dangerous 
to themselves, who have attempted, or are suspected of che- 
rishing a design to attempt, suicide. Dr. Black represents 
the proportion of suicidal to other maniacs as enormous. Of 
1972 patients admitted to Bedlam from 1772 to 1787, 323, 
or about one-sixth, are described as having attempted suicide. 
It is both a sound and a safe doctrine to regard all who have 
meditated or attempted to perpetrate this crime as insane. 
Accordingly, many of those here rated as maniacs unques- 
tionably owed their designation and their confinement to 
harbouring such an intention, and to no other overt act of 
folly or frenzy. The motives to destroy life vary with the 
pains and sorrows to which it is exposed, the capability of 
bearing these, and the general constitution with which each 
individual mind is endowed. But the resolution is often 
taken suddenly, and the hand is raised to accomplish the 
deadly purpose, while the mind is blinded by intoxication, 
tortured by bodily suffering, cast down by disappointment, 
maddened by momentary passion. When the poignancy of 
such disordered feelings has ceased, with it in a great number 
of cases will cease every inclination and temptation to com- 
mit suicide, and the mind will remain calm and undiseased ; 
so that of the 323 persons consigned to Bedlam because they 



82 WHAT ARE THE STATISTICS OF INSANITY, 

Lad yielded to the suggestions of a selfish and unholy cow- 
ardice,, probably not one- half would continue under the influ- 
ence of these feelings after the original impulse had been 
checked, a result which was very likely to flow from the act 
of isolation. This is a distinction of some importance, as 
such patients may be treated with confidence corresponding 
to what their dispositions are when relieved from the irrita- 
tation by which they were disturbed. To hold an opposite 
opinion will lead to the enforcement of all those galling pre- 
cautions, which offer little or no obstacle to the determined, 
provoke the vacillating, and harass the innocent. 

The number of suicides ma}' be estimated in one of two 
ways : either in proportion to the number of patients actually 
sent to and inhabiting asylums, or in proportion to the popu- 
lation of a country. The latter calculation affords some in- 
formation as to the average that may be expected to be 
committed to such institutions. There is only one link 
wanting to render the chain complete. We would require 
to know, but have no data from which to deduce, the propor- 
tion of suicides effected to suicides attempted, and the pro- 
portion of both to that of suicides meditated. I do not dis- 
pute the accuracy of Dr. Black's statement, nor deny that in 
a certain period the suicidal amounted to one-sixth of the 
whole of the lunatics confined in Bedlam; but I protest 
against the impression which such a statement is calculated 
to convey. I deny that such a proportion will be found in 
any other asylum. That the crime of suicide increases, that 
every year adds to the number of victims cannot be doubted. 
But the holocaust has not yet reached the appalling amount 
here announced. My own experience leads me to think that 
suicidal maniacs bear a proportion of about one-tenth to the 
other inmates of asylums. In a table of patients who have 
been under my own care, I find exactly this proportion. Of 
1032 deaths in the English asylums, only seventeen were 
brought about by self-destruction ; a fact which proves one 



WHAT ARE THE STATISTICS OF INSANITY. 83 

of two things, either the rarity of this species of derangement, 
or the excellence of the means adopted to prevent the fatal 
consequences which so frequently flow from it. 

One reason has already been given for separating suicides 
into classes — into those who may be trusted, and those who 
must be watched; another exists. It likewise proceeds from 
a consideration of the cause. Suicidal mania, like many other 
forms, is hereditary, whole families, generation after genera- 
tion, perish by their own act, the different members often 
selecting the same age and the same weapon for carrying 
their design into execution. When such a propensity has 
been transmitted, and is hence identified with the powers of 
mind, our watchfulness must be tenfold more strict and search- 
ing than when the incitement has consisted in an attack of 
the reflective or perceptive powers, which may be controlled, 
and which cannot recur without very marked premonitory 
symptoms. 

How easily lunatics may be diverted from their purpose 
by presence of mind, an intimacy with their character, and 
the tact to employ the destructive feeling by which they 
are actuated as the means of protection, is well exemplified 
in an anecdote related of Dr. Fox. He had accompanied a 
suicidal and furious maniac, who was at the time calm, to the 
upper story of his asylum, to enjoy the prospect beyond the 
walls. In returning the spiral staircase struck the eye of the 
patient, the opportunity roused the half-slumbering propen- 
sity, and a paroxysm of frenzy ensued. His eye glared, his 
teeth ground against each other, he panted like the blood- 
hound for his prey, and clutching the doctor by the collar, 
howled into his ear, " Now, I'll cast you down, and leap after 
you." Standing on the brink of what seemed inevitable de- 
struction, the doctor's reply was instantaneous, " Bah, any 
child could do that ; come down and I'll throw you up." 
" You cannot," was the rejoinder; but the artifice prevailed, 
and they both hurried down to put the boast to the proof; 



84 WHAT ARE THE STATISTICS OF INSANITY. 

and the sanguinary threat was forgotten before they reached 
the lobby. 

The proportion of suicides to the rest of the population is 
strikingly different in countries where the condition of the 
inhabitants is nearly similar. In Denmark it is higher than 
in Britain ; and in some of the German states it is a hundred 
times greater than in Copenhagen. In London the propor- 
tion is one in 5000 ; in Paris it is said to be one in 2040.* 
A very patriotic controversy has been waged by these cities 
as to which the stigma shall attach of presenting the largest 
catalogue of suicides. The contest is virtuous though idle ; 
and has brought to light facts which impugn even the accu- 
racy of the statements on which it has proceeded, and render 
it highly probable that no definite conclusion can be drawn. 
In Paris, it appears every person found dead, and whose death 
cannot be otherwise accounted for, is ranked as a self-mur- 
derer; whereas, in London, the want of evidence, and the 
complaisance of juries, often screen the suicide under the 
verdict of " died by the visitation of God." 

It is stated that in the departments of France, the number 
of deaths from suicide is comparatively small ; and, what may 
appear strange, the more primitive and illiterate the district, 
the smaller the proportion. We will accordingly find that 
the darker the ignorance the less the predilection to suicide. 
Thus, while in Finestre, which appears to be in the most de- 
plorable state as to education, only twelve in a hundred in- 
habitants being able to read or write, few suicides occur, at 
least only in the proportion of one in 25,000. Paris, that 
focus of all that is brilliant and imposing in science and liter- 
ature, and where gratuitous elementary instruction is acces- 
sible to all, gives a suicide for every 3000. Coreze, where 
only twelve in the hundred can read or write, presents one 
suicide in 47,000 ; and the High Loire one in 163,000. On the 

* Quetelet, Sur 1' Homme, t. ii. p. 147. 



WHAT ARE THE STATISTICS OP INSANITY. 85 

other hand, in Oise and Lower Seine, both places in possession 
of the highest degree of general instruction, and of the means 
of advancing in improvement, suicides occur in every 5000 or 
9000 inhabitants.* This is an appalling picture of demoral- 
ization, or of disease, but no hesitation can be felt in deter- 
mining the causes. It is not because these unfortunates can 
read or write, or live in a particular geographical position, 
that they commit suicide. But, first, because they are mem- 
bers of communities where the excitements to insanity, and 
the temptations to crime abound ; secondly, because the in- 
struction communicated is addressed solely to the reflective 
and perceptive faculties ; thirdly, because there exists no 
provision for the cultivation of the sentiments, by the aid of 
which man, as a citizen, is not only preserved negatively in- 
nocent, but is rendered positively virtuous ; there is no do- 
mestic tuition in France; there are none of the restraints 
which a prevailing morality imposes; there are in the semin- 
aries and public institutions the means of corruption; fourthly, 
because, as a nation, the doctrines of religion have been aban- 
doned. I speak not of a particular creed or form. That 
which the bulk of the people, and especially the well-inform- 
ed, have rejected, was sufficiently objectionable ; but the 
evil consists in this, that none other, or better, has been sub- 
stituted. With the superstitions and ritual of Catholicism, 
they appear to have cast aside all reverence for things sacred, 
and, in great part, the duties which such a reverence imposes. 
Connected with this inquiry is the fact that in the north of 
France, Catholicism has been nearly extirpated, and there 
suicide and crime predominate ; south of the Loire, on the 
contrary, it still retains a strong hold on the affections of the 
people, and there suicide, and its sister crimes or maladies, 
are comparatively rare. This affords a noble proof that the 

* Guerry, Essai but la Statistique Morale de la France. Buhver, 
France, Social and Literary. 



86 WHAT ARE THE STATISTICS OF INSANITY. 

effects of Christianity, in whatever form and under whatever 
circumstances, are peace and joy. 

There is still another consideration connected with this 
subject, as affording some hints, not how far, but with what 
a suicidal lunatic may be trusted. M. Guerry attempts to 
shew that every age has its favourite means of destruction ; 
that in youth and old age suspension is resorted to, in mid- 
dle age fire-arms. The pistol has its maximum, to use his 
mode of expression, between thirty and forty, while the rope 
rises progressively, and does not reach its maximum till from 
fifty to sixty.* Professor Casper's tables prove that in Ger- 
many, hanging is the most common mode adopted. Of 525, 
234, nearly one-half, died in this manner, while not more 
than nineteen effected their purpose by throwing themselves 
from the window.-j- These two expedients are in conse- 
quence of the present construction of our asylums, and of the 
furniture they contain, by far too accessible to lunatics, 
seeing that by building that part of the house destined for the 
reception of this class of one story, and by making the bed- 
pole incapable of supporting more than a few pounds weight, 
all danger might be avoided. Esquirol corroborates the 
conclusions of the authorities previously quoted. Of 198 
female suicides, he states that forty-nine employed hanging 
or strangulation, forty-five precipitation, and forly-eight ab- 
stinence. This table presents still another mode by which 
lunatics may baffle the wisest and most affectionate precau- 
tions. Fortunately, however, in an asylum death from vo- 
luntary starvation can rarely happen. The darker pages of 
medical history exhibit horrible scenes of forcing food into 
the throat, where teeth were broken, and. sometimes disloca- 
tion of the jaw took place. Modern sagacity has discovered 

* Guerry, Essai sur la Statistique Morale de la France. Quetelet, 
Sur 1' Homme, t. ii. p. 1.55. 

t Burrow's Commentaries, p. 447. 



WHAT ARE THE STATISTICS OF INSANITY. 87 

many ways of overcoming such stern obstinacy of purpose, 
few of which bear even the semblance of compulsion. M. 
Guislain dissents from the opinion now given, and declares 
that determined abstinence occurs in one-ninth of the insane, 
and that in more than a thirtieth part of these it is insur- 
mountable.* It is impossible to explain this fact, contra- 
dicted as it is by the experience of every British practitioner, 
otherwise than by referring it to some local peculiarity, to 
the prevalence of an epidemic of religious monomania, or, 
candidly, to some circumstance of which we are completely 
ignorant. In order to obtain the best and most recent infor- 
mation on a subject so important, I applied to the medical 
officers of two institutions where the most enlightened treat- 
ment prevails, and where regular records of the history of 
every case are preserved. From Mr. Mackintosh of Dun- 
dee Asylum, I learn, that among 650 patients admitted since 
the commencement of that establishment, there does not ap- 
pear to have been a single case of obstinate refusal to eat, 
followed by gangrene ; or, to use the gentleman's own ex- 
pressions, "any thing at all corroborative of what M. Guis- 
lain has advanced." Sir W. Ellis writes me, that in Han- 
well Asylum, where the daily average of patients is 611, 
there have not occurred above twelve cases in the last six 
years ; but that at Wakefield the proportion was about one 
in forty. 

Common observers passing through the parlours or work- 
shops of a properly conducted asylum, astonished by the 
decorum and business-like air of the scene, often make such 
remarks as, these people cannot be deranged, why are they 
not sent home ? Even those who ought to have been ac- 
quainted with the real state of matters, have clamoured in a 
similar strain, and arraigned the detention of individuals 
whose deportment might appear to elicit such indiscriminat- 

* Gazette Me'dicalc de Paris. Janvier, 1836. 



88 WHAT ARE THE STATISTICS OF INSANITY. 

ing interference, as an act of gross oppression and barbarity. 
The perspicacity of that mind must be very questionable 
which cannot penetrate the thin veil of correct demeanour 
which disguises the wandering thought, or wild passions of 
the maniac. The tranquillity which reigns among the insane 
is not deceptious, it is not the silence of fear, nor the specious 
blandness of affectation ; but yet it must not be received as 
revealing the healthy serenity of those hearts from which it 
springs. Its sources are three : the} r are all pure and heal- 
ing. It may flow from the incapacity of the mind to expe- 
rience any other than present or animal enjoyment; from the 
subsidence of the maniacal paroxysm, in other words, the 
presence of a lucid interval ; and, lastly, from that calmness 
which occupation and other modes of abstraction are intended 
to produce, and which, when permanently established, ren- 
ders all subsequent measures comparatively easy. But to 
release patients in any of these states, would be to place them 
in the very circumstances calculated above all others to 
destroy this superficial peace, and agitate the mind in its 
deepest recesses. There may be some difficulty in deciding 
what shall be called a lucid interval, and how it shall be dis- 
tinguished from the stage of convalescence. The experience 
of all practical men is, that much more is lost than can pos- 
sibly be gained by an early restoration to society, and their 
advice accordingly is to subject a patient to as long a period 
of trial and observation as may be consistent with justice. 
The only guide to a correct judgment is the fact of the com- 
plete disappearance of every symptom of nervous disease. 
During a lucid interval there generally linger some aberra- 
tion of thought, some bodily disturbance. During conva- 
lescence, no irregularity of function can be detected. Re- 
lapses have been separated from recurrences of insanity : the 
former being limited to all new attacks which occur within 
three months after recovery ; the latter including all at more 
distant periods. The distinction maybe scientifically just; 






WHAT ARE THE STATISTICS OF INSANITY. 89 

but it is not practically useful. For, if whenever a patient 
is brought into contact with the world, and the rude shocks 
which the current of its affairs inflicts upon delicate and re- 
tiring natures, an overthrow of reason ensues, it is of very 
little importance what the duration of the interval may have 
been ; as, whether of three or twelve months, the re-appear- 
ance of the insanity in the same form, and from a similar 
cause, cannot be regarded in any other light than as a re- 
lapse. I have known patients continue perfectly sane for 
ten or twelve months, and then fall into the most ungovern- 
able paroxysm of mania on certain emotions being called 
up, and whose sanity thus depended upon the discretion of 
those around. There are indeed many individuals who are 
comparatively or entirely sane when under the guardianship 
of an asylum, who would become furious or melancholic if 
compelled to mingle in a busier and more exciting scene, and 
to bear the burden of an active life. 

The Parisian registers furnish some very interesting facts 
on this subject. From them it appears that the relapses are 
to the admissions as four to one hundred, and that the re- 
lapses to the cures in both sexes are as twelve to one hun- 
dred. But on examining the proportion in the sexes sepa- 
rately it is found to be twenty per cent, in males, and only 
ten per cent, in females. What is the cause of such a dis- 
parity ? it may be asked. The explanation seems to strength- 
en the views I have adopted. " The medium residence," I 
quote Burrows, " of each man discharged cured is four 
months and fifteen days : that of each woman discharged 
cured nine months and twenty-five days." Now this proves 
most incontestibly either that the removal of the disease is 
more difficult in women than in men, which is preposterous, 
or that the longer the influence of good treatment is continu- 
ed the greater will be the security of the individual. Assur- 
edly it is purchasing an immunity from madness at a cheap 
rate to reside for a short time with friends whose reputation 



90 WHAT ARE THE STATISTICS OF INSANITY. 

is, to a certain degree, interwoven with the health of their 
charge, and under a roof which, while it may remind of the 
childishness or frenzy of alienation, cannot fail to be endear- 
ed by recollections of the return of intelligence and feeling, 
of the rising and renewed glory of the sun of reason from the 
darkness of despair. To give any practicability or usefulness 
to this suggestion, steps must first be taken to assimilate asy- 
lums to the homes to which patients are desirous and are 
destined to return. They must have within themselves temp- 
tations to induce a protracted residence which it might be 
hurtful to extort. They must become boarding houses of the 
best description, where medical attendance and moral train- 
ing shall be as unremitting as during the acute stage of the 
disease ; and where there shall exist certain outlets, channels 
of communication with the external world, through which 
old impressions may be gradually revived ; old friends reun- 
ited, and the resumption of former habits and pursuits safely 
accomplished. 

Complete isolation is as pernicious to the curable insane 
as to the sane. The experience derived from the American 
prisons and penitentiaries proves that the mind, when totally 
deprived of the stimulus afforded by social intercourse and 
occupation, gives way, and fury and fatuity succeed. Is this 
result at all allied, or more closely than by analogy, to the 
breaking up of the constitution, observed in the suddenly 
reclaimed drunkard ? I have tried the experiment of com- 
plete isolation. The effect was tremendous. A noisy and 
ferocious maniac was in the course of a few weeks altogether 
subdued, even his diseased energies seemed to be prostrated 
by their own unrestrained violence ; but at the same time 
the mind was enfeebled by the deprivation of every impres- 
sion from without, and I for some time trembled lest the cure 
of furious mania should prove to be fatuity. To the incur- 
able and dangerous insane, whose alienation admits of no al- 
teration from companionship or external nature, who live 



WHAT ARE THE STATISTICS OF INSANITY. 91 

within themselves, solitary confinement is neither injurious 
nor irksome. 

The number of cases is very small which would not be 
benefited by modified isolation, or rather by separation from 
the places, and persons, and impressions, causing or connect- 
ed with the origin of the disease. Were all asylums proper- 
ly conducted ; were they what they ought to be, and pretend 
to be, hospitals adapted for all forms of mental alienation ; 
then all forms would be alleviated by this mode of treatment. 

From mistaken kindness or an erroneous estimate of the 
soothing and curative powers of friendship and affection, a 
trial is frequently recommended to be made at home. Seve- 
ral months after the incursion of the complaint are thus 
spent in an experiment, in hoping, in grieving over the gra- 
dual extinction of the noblest attributes of mind, but in doing 
nothing. The man who would recommend a patient labouring 
under inflammation of the lungs to try the effects of the kind 
attentions of his relations, water-gruel, and the nurse's phar- 
macopoeia, would be reprobated as an ignorant fool. The 
man who gives similar advice to a patient labouring under 
inflammation of the brain, or diseased action closely resem- 
bling it, scarcely deserves to escape from similar reprobation. 
From this advice being followed, it is comparatively rare for 
the superintendents of public asylums to have recent cases 
submitted to their care. Of one hundred and forty-nine pa- 
tients admitted to the Retreat, at York, in the course of fif- 
teen years, only sixty-one were recent cases.* 

The chances of cure are consequently diminished, unjust 
conclusions are drawn as to the curability of the disease, and 
the real advantages of judicious treatment rendered abortive. 
The reasons why we are more successful in cases of short 
standing are very obvious. After the agitation consequent 
on a sudden separation from society has subsided, or the 
acute stage of mania has been mitigated, there are the for- 

* Tuke's Description of Retreat, p. 201. 



y^ WHAT ARE THE STATISTICS OP INSANITY. 

mer habits of the patient still imprinted vividly on the mind, 
and arising more naturally to recollection than new combi- 
nations of thought ; there is the languor of idleness, the crav- 
ing for variety ; there is the instructive desire to escape from 
self, and the equally instructive suggestions of making the 
hands work instead of the head to effect this escape : there 
are all these and many more conditions to be worked upon 
which do not exist, or do not exist to the same extent at any 
subsequent period. The mind is then more alive to the sti- 
mulus of emulation, rewards, punishments, and threats. I 
have not alluded to the paramount, that is, the physiological 
reasons for early treatment. 

In the application of labour as a remedy, it is of impor- 
tance to know what number of patients may be expected to 
co-operate, and should it be suited to their condition, to work 
out their own cure. By using the proper incentives ninety 
out of every hundred recent cases may be induced to do this, 
provided there exist no physical disability, such as palsy, to 
prevent the attempt. Even in old cases where the mind and the 
muscles have been allowed to slumber, or to struggle in the 
restlessness of pain for twenty years, wonderful transforma- 
tions may be accomplished ; and so potent and infectious is 
imitation, so exquisite is the pleasure of being roused to ac- 
tivity, and of being tranquillized by having a specific objecl 
to action presented, that two-thirds of those affected may be 
employed, and the hoary headed lunatic who has dreamed 
away a quarter of a century may be converted into a busy ; 
bustling, and highly useful personage. It appears from the 
report of Sir W. Ellis, that of 610 patients in the asylum al 
Hanwellduring 1836,431 were constantly employed. In Dun- 
dee asylum, during the year 1834-35, ninety-two of ninety-sis 
paupers Were engaged in various branches of industry, from 
picking oakum and mending shoes up to flowering muslin and 
upholstery work. The Richmond asylum has one half, or 13C 
out of 377 constantly contributing to the support of the in- 



WHAT ARE THE STATISTICS OF INSANITY. 93 

stitution and to their own restoration. In that establish- 
ment another principle, that of tuition, is directed against 
insanity. Twelve of the 130 were learning to read, This 
noble and most philosophical attempt to build the mind anew 
on the ruins of outraged feeling, or enfeebled judgment, or 
whatever may be the form of the injury sustained, by con- 
veying new ideas to the perceptive powers, and by calling 
up, by means of education, faculties which were previously 
unknown or dormant, and which may prove to be healthy 
or antagonist to those diseased — has been made elsewhere ; 
and on a more extended scale, patients have been instructed 
in the rudiments of science, in drawing, music, have been 
taught weaving, shoe-mending, and other common arts, and 
have been even tempted to participate in the representation 
of comedies.* The fact is so evident that the mind must be 
relieved from sorrow or any other painful impression by dis- 
traction that the humanity of resorting to occupation for this 
purpose is universally admitted. But it may not follow that 
because the mind is relieved from pain it is consequently 
placed in the best condition to recover ; in other words, does 
employment promote cure ? The presumption that it is 
capable of doing so is founded upon a very familiar precau- 
tion. We do not use a leg or an arm that has been bruised 
or wounded or is inflamed ; we endeavour to save it from 
exertion, and allow it rest by employing the other. In pre- 
scribing occupation then to the insane, it is proposed to en- 
gage the healthy, the unwounded powers and thereby to save 
those which are pained or diseased, and would be injured by 
exertion. If a man, who imagines himself an outcast from 
society, the object of contempt and scorn, be placed at a 
loom., and induced to produce ten or fifteen yards of cloth per 
day, it is quite clear, that during the execution of his task, if 

* Wendt's Account of Asylums in North of Europe ; quoted in 
Pritchard. Annales d'Hygiene ; Juillet, 1836. 



94 WHAT ARE THE STATISTICS OF INSANITT. 

it be done well, he is forced to exert his whole attention and 
no little ingenuity and manual dexterity upon the manag- 
ment of the shuttle, beam, &c., that while his mind is so di- 
rected, it cannot be under the dominion of its morbid sor- 
rows ; that just in proportion to the degree and duration of 
the occupation will be the freedom from disease and the 
nearer approach to health. 

But there are other objects than abstraction gained by this 
system. It gives a regularity to the mental operations, than 
which nothing can be more conducive to tranquillity : it 
imposes the necessity of self-command and attention, it 
communicates new series of impressions, and if judiciously 
managed, it may be made, by giving tone and vigour to the 
body, to react on the mind, in the same manner that eva- 
cuants, opiates, or tonics do. It cannot then be immaterial 
what the nature of the employment is which may be recom- 
mended. In the selection, let the object be to combine as 
many of the objects here specified as possible. It is not 
enough to have the insane playing the part of busy automa- 
tons, or to wear out their muscular energies vicariously, in 
order to relieve the drooping heart of its load. There must 
be an active, and, if possible, an intelligent and willing par- 
ticipation on the part of the labourer, and such a portion of 
interest, amusement, and mental exertion associated with the 
labour, that neither lassitude nor fatigue may follow. The 
more elevated, the more useful the description of occupation 
provided then, the better. It ought not to be complicated, 
for that would discourage : it ought not to be purely me- 
chanical, for that frustrates the end in view : it ought not to 
be useless and evidently for the purpose of acting as a 
means of abstraction, for the artifice is often detected, and 
the patient is disgusted. The utility of every thing ordered 
should be palpable ; and this argument holds out another in- 
ducement to engage every individual in the pursuits to which 
he has been accustomed. Pinel mentions the case of a mad 



WHAT ARE THE STATISTICS OF INSANITY. 95 

watchmaker, who spent many months in experiments on the 
perpetual motion. He, of course, failed to solve the problem, 
but regained his reason in the attempt. With a view to se- 
cure the benefit of exercise in the open air, as well as mental 
concentration, field-labour has been much resorted to, and 
asylums have been surrounded by farms, and parks, and gar- 
dens. The plan is unexceptionable, and whereverit can be car- 
ried into effect, will promote the restoration of those engaged. 
But however excellent in certain circumstances, it is quite 
clear that its application must be partial, that it can only take 
place during particular seasons of the year, and can include 
a very small class of lunatics admitted into urban asylums. 
Military exercise has been substituted in some countries; and 
however ridiculous it may at first appear, that a battalion of 
lunatics should perform the evolutions of a well-disciplined 
corps, the moral result has justified the expedient. I confess 
to have seen the drill-sergeant work miracles. But even 
here fine weather is required for the daily drill ; and what 
we are in search of is some employment which shall be ac- 
cessible and in constant operation, altogether independently 
of climate, or any accessory circumstance. The best rule is 
to have all descriptions of occupation at command ; and 
where a sedentary one is chosen, or preferable, to suggest 
walking or swinging as a recreation and interruption, or to 
devise means that the necessary amount of exercise be taken. 
Wherever people of education are confined, a thousand ex- 
pedients may be adopted to occupy and amuse. But as ar- 
tisans and tradesmen furnish, and must always furnish, the 
greatest proportion of the insane poor, all, or at least the 
principal arrangements should be adapted to their wants, 
and for their benefit. Whatever the staple trade of the dis- 
trict, its implements, or the means by which it is carried on, 
should be found in the asylum ; and not only this, but every 
reasonable provision for engaging those workmen, who must 
lie members of every community, and be found in every dis- 



96 WHAT ARE THE STATISTICS OP INSANITY. 

trict. Weavers, shoemakers, tailors, gardeners, carpenters, 
watchmakers, have all been tried for years, and found to 
work as diligently, and to produce as good articles when 
confined as when at liberty. I cannot indeed see, nor admit, 
any limit to the application of the principle. 

But conceding its practicability, it may be demanded, is 
it safe ? Can the maniac be intrusted with instruments of 
the most dangerous, and, if he should so incline, deadly kind ; 
which, wielded by the tremendous force that he is well known 
occasionally to possess, would enable him to sacrifice all 
around, and then destroy himself? If there be any superiority 
in the modern mode of studying the dispositions of the in- 
sane, it consists in the power of discriminating those who 
may be allowed to be set free from those who would abuse 
liberty, and those who may be allowed with impunity to use 
.knives, hatchets, &c. in their ordinary calling, from those 
who may not. No man, unless mad, would place a knife in 
the hands of a patient of whose character he was ignorant, 
or whose character for revenge and cruelty he knew. But 
nine-tenths of madmen are neither habitually malicious nor 
furious ; and if they satisfactorily pass the ordeal of such ex- 
amination as it is in the power of every man acquainted with 
the human mind to institute, it would be egregious folly to 
debar them from a privilege which may contribute to their 
happiness, and cannot, in ninety cases out of a hundred, in- 
terfere with the happiness or safety of others. In the Rich- 
mond Hospital, where 130 individuals are constantly pos- 
sessed of cutting instruments and other objects which could 
be readily converted into weapons of destruction, no acci- 
dent has ever occurred. Murders are sometimes perpetrated 
in asylums ; but far more rarely than among the sane in- 
habitants of the world ; and in almost all cases where such 
misfortunes happened, they have been traced to one of two 
causes, either to the intemperate language and brutal con- 
duct of a keeper, or to the improper classification of the pa- 



WHAT ARE THE STATISTICS OF INSAITY. 97 

patients. At Sonnenstein no accident is recorded. Sir W. 
Ellis has pursued this plan first at Wakefield, latterly at Han- 
well, in the treatment of several thousand patients, and his 
courage, confidence, and discernment, have been justified 
throughout. With the limitations mentioned, indeed, there 
is no respectable establishment where employment, in its 
widest sense, is not considered the grand specific, and every 
successive improvement grounded upon its extension. 

Possessed then, of such accurate knowledge of all that is 
to be dreaded and all that is to be hoped in the treatment of 
the insane, it remains to be inquired, have the arrangements 
made to effect the great end in view been founded upon this 
knowledge ? have they been in accordance with the laws of 
the human mind, and the precepts "love mercy, do justly ?" 
or have they sprung from the less noble sources, ignorance, 
indifference, selfish interests ? To this inquiry the next lec- 
ture is devoted. 



LECTURE III. 



WHAT ASYLUMS WERE. 



Character of System pursued previous to 1815 — St. Vincent de Paul — . 
Insane consigned to Monks — Lunatics set at large to beg — Lunatics 
in Gaols, in Cages, in Caves, in Dungeons. — Associating of Lunatics 
with Criminals — Modes of quieting Lunatics — "Muffling" — Modes 
of feeding Lunatics — "Forcing" — Death from this process — Lunatics 
in Hospitals — Four or five sleep in one bed — Confined in Venereal 
Wards — Lunatics in Workhouses — Want of Medical attendance, 
classification, comfort, and cleanliness in these establishments — Sale 
of Idiot children — Madhouses at Venice, Nantes — Confinement of 
sane individuals — Carelessness of Medical men in granting certifi- 
cates^ULJnusual modes of coercing the Insane — Coercion required for 
the poor, but not for the rich — Coercion resorted to as economical — 
Lunatics exhibited for a sum of money ; excited and induced to gorge 
themselves with food, or filth, for the amusement of visitors — Gan- 
grene of extremities from cold — Insufficient supply of food, of cloth- 
ing — No medical or moral treatment — Superintendence confided to 
ignorant and dissolute keepers — Terror as a remedy — Cruelty and im- 
morality of servants — No separation of sexes — Unhealthy cells — Con- 
cealment of mortality — Deaths from fury of keepers and patients — 
Records burned to frustrate inquiry, &c. — A visit to Asylums as they 
were. 

There exists no wish in my mind, as ma^^ be supposed 
from the details contained in this lecture, to produce a false 
impression in order to excite a strong feeling of sympathy in 
the fate and fortunes of those whom I regard as my clients. 
Their sufferings are, unfortunately, so numerous and so cla- 
mant as scarcely to admit of exaggeration. But it is my 
wish to tell the whole truth, and to expedite the cause of 



WHAT Ao^UMS \F£RE. »» 

humanity, although the sensitive may be shocked, or the 
fastidious disgusted by the recital, although even the real 
philanthropist should be conscience-stricken that his energies 
have been expended on miseries less poignant and pressing, 
and on objects of compassion less worthy. 

What then were formerly the provisions for the cure of 
the varieties of lunacy, and for the various classes of luna- 
tics which have been considered ? u Nos peres n'ont pas ren- 
verse," says a French writer in 1833, " toutes les Bastilles." 
The atrocities which have been perpetrated within these bas- 
tiles, deridingly called asylums, under the pretence, and, in 
some cases, it is possible, at the dictation of benevolence, and 
under the sanction of science, are too little known to the pub- 
lic. Although belonging to the past, and generally repudi- 
ated at the time by those who from ignorance, or some less 
excusable cause, tolerated their continuance, they require to 
be exposed in order to accelerate as much as possible the 
progressive improvement, which shall destroy every lingering 
remnant of the system from which they sprung, every trace 
of their existence and influence. 

It may appear presumptuous that I should volunteer to 
preach a crusade in this cause : but he who moved and led 
the whole Christian world in the first crusade, was nearly as 
humble an individual as your lecturer, and certainly not more 
sincere. My only justification, if any be required, is, that 
my professional studies and pursuits have rendered me fa- 
miliar with the principles upon which institutions for the 
cure or reception of the insane have been, in contradistinc- 
tion to those on which they ought to have been conducted. 
I am likewise actuated by the desire to show, that practi- 
cal men have been unjustly regarded as inimical to the 
changes which the theoretical have proposed. At present 
reference shall be made only to some of the errors, absurdi- 
ties, and atrocities of the old system, as they obtained pre- 
vious to the year 1815. Buried in those valuable though 



100 WHAT ASYLUMS WERE. 

little valued monuments of legislative industry and wisdom? 
Parliamentary Reports, or scattered through periodicals or 
other works nearly as ephemeral, the facts upon which this 
exposition will proceed, rarely if ever meet the eye of the 
general observer or philosopher. As an indication of the 
better spirit which now prevails they will appear scarcely 
credible. But though the characters be written in blood, 
the accuracy of the tale they tell cannot be questioned. 

Until the noble efforts of St. Vincent de Paul were crowned 
with success, the madman was, on the continent of Europe, 
either expelled from society as an outcast unworthy of 
care or compassion, or burnt as a sorcerer unworthy even 
of those rude forms of justice which then prevailed. This 
pious man was a divine, and is now a saint of the Catholic 
church. If canonization ever was justifiable or excusable, 
it Was in this instance. St. Vincent sacrificed every thing 
for these outcasts : he journeyed from land to land to preach 
and propagate the cause of charity : his mission was to 
bring back the sympathies of our nature to their proper 
channels, to proclaim that the darkened mind was as much 
the visitation of God as the darkened vision, and that Chris- 
tianity demanded of the humane and virtuous and powerful 
to protect, and the skilful to relieve, the one as well as the 
other. The hearts of nations responded to his call. He 
became the emancipator of the diseased, the reviled and per- 
secuted, during all succeeding ages. Of the same type and 
mould as La Rochefoucauld and Howard, he worthily obtain- 
ed the glorious epitaph, " The father of the poor, the stew- 
ard of Providence." May the spirit and enthusiasm which 
actuated, him be ever present to those who are now intrust- 
ed with the good work which he commenced ! He was at 
the time of his labours a monk, and from this circumstance 
perhaps, or because these recluses were then the principal 
depositaries of all knowledge, scientific as well as religious, 
in the countries to which his exertions were confined, to 



WHAT ASYLUMS WERE. 101 

monks was the care of the insane confided. For nearly two 
centuries they discharged this trust ; — how ignorantly and 
barbarously, may be judged from the treatment stated to have 
been pursued in a monastic establishment in the south of 
France. There every lunatic regularly received ten lashes 
per day. To ascetics, however, who, themselves, shrunk 
from neither lash nor torture, this regimen might appear 
both beneficial and reasonable. Convents were, until the 
Revolution, the only receptacles for the insane in France : 
in Britain asylums existed at an earlier period. But of what 
kind? 

The reign of humanity in Bedlam commenced only about 
twenty years ago. Before that period the lunatic might be 
truly said to live under a reign of terror. Immured in a 
wretched and comfortless prison-house, and left to linger 
out a lifetime of misery, without any rational attempt at 
treatment, without employment, without a glimpse of happi- 
ness, or a hope of liberation, he was terrified or starved into 
submission, lashed, laughed at, despised, forgotten. The 
great objects were — confine, conceal. Protect society from 
his ferocity : protect his sensitive friends from the humiliat- 
ing spectacle of such a connexion. Regarded as wild beasts, 
all maniacs indiscriminately were treated as such ; nay, the 
imprisoned tiger enjoys a milder fate, for his keepers have 
an interest in his health and preservation. That this is a 
mitigated rather than an exaggerated summary of horrors, 
will presently appear. Until very recently, such lunatics as 
could not with safety be suffered to roam at large, were con- 
fined in common prisons. Parliamentary returns prove, that 
a few years ago, there were in Scotland, at least a thousand 
lunatics at large, and consequently denied all provision for 
their recovery. It is not a little illustrative of the utter in- 
adequacy of the establishments formerly appropriated to the 
insane to the end proposed, and of the crude, or cruel views 
which were entertained of the nature of their disease, that 



102 WHAT ASYLUMS WERE. 

it was either necessary or customary to discharge from Beth- 
lem a number of lunatics, who, with a dress and manners as 
grotesque as their delusions, wandered from house to house 
and town to town, a sort of privileged paupers, long known 
as Tom o' Bedlams, living no one cared how, and dying no 
one cared where.* This hospital-delivery occurred, of 
course, at a remote period, and was resorted to for the pur- 
pose of relieving the institution of the burden of maintain- 
ing a set of incurable madmen. 

If those who were east into gaols were docile and inoffen- 
sive, they were permitted to mingle with their fellow-cap- 
tives and become their butt : if noisy or furious, they were, 
of course, condemned to the deepest and darkest dungeon 
which the house afforded, and never visited by a medical 
man except when afflicted with some disease superadded to 
their alienation, if even then. In Ghent the intractable 
were inclosed in wooden boxes or cages. Strange to say, 
at Eberbach, where considerable advancement seems to 
have been made in classifying patients, a large iron cage is 
still constantly used for confining the refractory and dan- 
gerous.f At Strasburg these dens were only four feet wide 
and six feet in height. Through the spars was tossed the 
litter upon which the half naked maniac reposed : food was 
conveyed to him in the same manner ; and from the ribald 
jest, or harsh commands of the attendants, he had no pro- 
tection ; he was indulged in neither darkness nor solitude ; 
his tormentors were ever before him. But even here misery 
had not reached its maximum. At Mareville the cages 
containing the patients were placed in cellars : at Lille they 
were confined in what are styled subterranean holes : at 
Saumur they inhabited cells without windows, and were 



* D'Israeli. Curiosities of Literature. First series. Vol. iii. p. 354. 
t Bubbles from the Brunnens of Nassau, p. 290. 



WHAT ASYLUMS WERE. 103 

provided with wooden troughs filled with oak bark as beds.* 
Revolting as these disclosures are, 1 feel myself bound to 
make them, in order to show from what a degrading state of 
ignorance and brutality we have escaped, and from what 
complicated misfortunes the objects of our care have been 
rescued by the diffusion of knowledge. These examples 
were not peculiar to any country. They have been select- 
ed merely because they are the best authenticated. But to 
what place and to what period would you conclude the fol- 
lowing description to apply. "On visiting the gaol of , 

a high legal functionary found that the gaoler was absent at 
work, and being sent for, declined to attend. There was a 
vault in the gaol in which a maniac was kept, who, twenty 
years ago, had been sentenced to imprisonment for life for 
killing a man. The individual who attended broke the key 
in attempting to open the door of this vault ; but enough 
was seen to show, that the place in which the miserable man 
was kept, was of the most wretched description."-]- This 
memorable visit was paid in 1834 : the prison is in our own 
free and enlightened land, the legal officer was the Solicitor 
General, and my authority is Mr. A. E. Menteith, univer- 
sally known for his probity and piety. Now, who will dare 
to assert, that this miserable creature, this homicidal maniac, 
who, in some paroxysm of frenzy, perhaps unconsciously, 
had imbrued his hands in blood, retained, during the long 
period of his confinement, the same sanguinary ferocity 
which had prompted to the crime : who dare assert, that if, 
in place of being chained in a subterranean dungeon for half 
a lifetime, he had been placed in favourable circumstances, 
a period of tranquillity and serenity, and even of sanity, 

• Esquirol. Diet, des Sciences Med. art. " Maisons des Alienes." 
Sc. Pinel. Traite Complet du Regime Sanitaire des Alienes, p. 64. 

•f- Speech delivered by Alex. E. Menteith, Esq. advocate, at the 
First Annual Meeting of the Prison Discipline Society of Scotland, 
Edin. 1836. 



- 



] 04 WHAT ASYLUMS WERE. 

might not have arrived, when a feeling of responsibility and 
repentance might have given at once strength and humility to 
the mind, and formed the commencement of a life of useful 
industry and virtuous contentment. None of these antici- 
pated results might have followed a more lenient and rational 
treatment in this case ; but the gravamen of the charge, the 
.matter for deep regret is, that any human being, labouring 
under mental disease, should be abandoned, without an 
attempt at cure or alleviation, to the custody of a coarse and 
negligent turnkey, and condemned to endure privations to 
which the household dog is never exposed. " The accom- 
modation for the insane," says Mr. Rice, " in the Limerick 
Asylum, appears to be such, as we should not appropriate 
for our dog-kennels."* The civil authorities had formerly 
no alternative but to confine the pauper lunatics of the dis- 
trict in the nearest gaol, or lock-up house. The evils of such 
a procedure were even greater than that which has been dis- 
cussed. There then existed, as there now, I believe, exists, 
no classification among the prisoners ; and the lunatics, if 
calm and obedient, were forced to associate with all who 
might be placed in the common room. The unfeeling taunts 
of the heartless and debased criminals were the least promi- 
nent of these evils : such callous persecution could inflict but 
momentary pain, could but aggravate the disease ; but to 
minds naturally weak, enfeebled by excitement, or recover- 
ing from derangement, the constant and friendly intercourse 
of such polluted companions must have proved doubly de- 
trimental, by corrupting every virtuous disposition and over- 
throwing every principle of religion. The man who was 
cast into prison a moping fool, ran the risk of being dis- 
charged a reckless villain. But in these moral lazar-houses 
the witless noise of the maniac was often found to be inimi- 
cal to the repose of the other inmates, and how, will it be 

* Report from the Select Committee on the Lunatic Poor in Ire- 
land, &c. 1817, p. 14. 



WHAT ASYLUMS WERE. 105 

supposed, were they soothed to sleep and silence ? Intimi- 
dation is not, it was discovered, an infallible remedy in 
mental medicine ; it will occasionally defeat its own object 
and convert irritation and discontent into absolute fury and 
despair. But cruelty is ingenious, and these practitioners 
adopted the alternative of bleeding their patients to debility, 
or drugging them with opiates. A less refined mode of 
obtaining tranquillity was sometimes resorted to in mad- 
houses, designated, in the revolting slang of its inventors, 
" muffling" — which consisted in binding a cloth tightly over 
the mouth and nostrils, or, as a person who had witnessed 
its application graphically describes it, " tying a bit of sheet 
or something round the nose to stun the noise, to see if it 
would quiet them.""' Connected with this infamous custom 
was another called " forcing." Patients often refuse to take 
food. They suspect it to be poisoned : they imagine it to be 
unwholesome, or to be human flesh : they conceive that 
they are commanded by an angel to refrain from gratifying 
their appetite ; or, finally, from obstinacy and perversity of 
character, they resist all solicitations to eat. They were, in 
times gone by, believed to be inaccessible to reasoning or 
persuasion, and no such means were adopted to overcome 
their resolution. Strength of arm was then the remedy for 
all difficulties. And the struggling victim was bound down 
on a bed, the teeth forced asunder, and the dreaded sub- 
stance pushed or poured down the throat. Occasionally 
teeth were broken or pulled from their sockets, and we hear 
of the handle of a spoon — this was the instrument generally 
selected for the operation — being forced through the palate 
during the contest ; but these consequences were looked 
upon as trifles.f They were in reality so when compared 

• First Report of Minutes of Evidence from Committee on Mad- 
houses, 1816, p. 30. 

f First Report of Minutes of Evidence from Committee on Mad- 
houses, 1816, p. 2, and 80. 



106 WHAT ASYLUMS WERE. 

with what frequently ensued. To facilitate the descent of 
the food, the head was unavoidably bent backwards and 
placed in so unnatural and dangerous a position, that any 
sudden or powerful movement on the part of the patient 
rendered dislocation of the vertebrae almost unavoidable. 
When the throat was strongly grasped in this attempt, suffo- 
cation may have taken place, but the instantaneous death of 
some of the victims, whose history is recorded, would lead 
to the belief, that pressure on the spinal marrow had been 
the cause. What adds to the horror with which we must 
regard the practice, adopted although it may have been from 
a mistaken compassion, is, that it was not resorted to in 
desperate cases only, when long continued fasting, debility, 
and the prospect of death from inanition might justify or 
palliate such violence, but whenever a single meal was re- 
fused. The tyrants would permit neither the stomach nor 
the mind to be refractory. A female in a private Asylum 
expressed her unwillingness to eat : she was immediately 
forced, and is said to have died under the hands of the keeper. 
Four or five times a-day would the same practice be had re- 
course to, and if any disaster occurred, there appears to have 
been no troublesome friends or coroner's inquest to tell the 
tale. The following event is said to have taken place in the 
same establishment, and will exemplify both the cruelty and 
indifference displayed by all concerned in such proceedings. 
A gentleman refused his food : the keeper forces, from no 
revengeful inhumanity perhaps, but still he forces him to 
take it, the patient calls for assistance in the piteous words, 

" For God's sake, Mr. , come and help me, or I shall 

be killed by this man." No entreaties either on the part of 

the sufferer, or the other servants, could induce Mr. , 

who was seated in an adjoining room and within hearing of 
the scuffle, to interfere. All becomes suddenly still : the 

keeper quietly reports to Mr. , that the gentleman 

went off in a fit during the act of forcing, and no further 



WHAT ASYLUMS WERE. 107 

notice is taken of the matter.* The truth of these state- 
ments was denied at the time by the persons implicated. 
Could it be otherwise ? I cannot say, strongly as I desire 
to disbelieve such a charge, that the evidence adduced of the 
inaccuracy of the details, or of the vindictive bias of the ac- 
cusers, is by any means satisfactory or conclusive. But my 
accusation is not levelled against these or any other parties, 
but against the practice. Exonerating those in whose hands 
such distressing accidents happened, from all cool, deliber- 
ate cruelty, or even disregard for the lives of those committ- 
ed to their care : and even admitting that the particular 
instances cited may have been exaggerated : yet, is it no 
less true, that interference of the nature here described is 
generally an uncalled-for exercise of authority, is always 
attended with severe suffering and some danger, and cannot 
be regarded in any other aspect than as the most cruel alter- 
native which the duty of a curator of the insane can force 
him to adopt. Nor is it to be concealed, that such means of 
administering food were in many respectable asylums con- 
ceived to be indispensable, and that injuries were inflicted 
where no blame was attachable except to the abominable 
custom itself. " It is the general practice in all houses I have 
visited," says a medical witness before the Committee of the 
House of Commons.f 

Hospitals were sometimes preferred to prisons abroad, and 
that at a time when they deserved to be regarded rather as 
places for the concentration and aggravation, than for the 
relief of disease : when four, five, or more individuals slept in 
the same bed, and cleanliness and ventilation were treated 
as vain mockeries. J In the Hotel Dieu of Paris, previous 
to the conversion of a part of Salpetriere into an hospital for 
the reception of the curable insane, lunatics in whatever 

* First Report of Committee, &c. 1816, p. 86. 
•f First Report of Committee, &c. 1816, p. 5. 
± Diet, des Sciences Med. art. " Maisons des Alienes." 



108 WHAT ASYLUMS WERE. 

stage, and presenting whatever features of mental derange- 
ment, were confined in a hall adjoining the fever-ward, which 
contained beds for four persons, and two small beds ; this 
accommodation being intended for forty-two patients. In- 
dividuals affected with hydrophobia were classed with the 
insane and placed in the same apartment.* A similar disre- 
gard to personal cleanliness and comfort, and to those laws 
which regulate both the preservation of health and the pro- 
gress of disease, appears to have crept into some of the es- 
tablishments in this country at a comparatively recent period. 
The Inspector of Naval Hospitals found, in one house where 
insane officers and seamen are received, " in a ninth bed- 
room three officers, one of whom was totally insensible to 
the calls of nature, and slept in a double cradle with an offi- 
cer who was cleanly in his habits. I found three officers in 
a tenth apartment, containing pauper patients : a private 
seaman slept in a double cradle with one of these officers."f 
I believe that a partition of some kind divided these cradles 
into two resting places. Again, the Commissioners for re- 
gulating Madhouses affirm, that in one place they found 
«.' not less than twenty persons ill of fever : a young girl 
was in the same bed with a woman who was dying : some 
women were lying on the floor, and others at different ends 
of the same bed.";); Even one of the Commissioners of 
Madhouses makes this singular admission. " It is a wrong 
thing, but it cannot be expected that a man who pays only 
ten shillings a-week should have a separate bed." So re- 
cently as 1788, Iberti conceived it necessary to justify the 
propriety of separating lunatics from the other patients in a 
public hospital, and of placing them in distinct wards; he did 
not venture to propose to place them in distinct buildings. 
Asylums existed in England at the time he wrote, and ap- 

* Tenon. Memoires sur les Hopitaux de Paris, p. 214>. 

•»• First Report of Committee, &c. 1816, p. 25. 

| Fourth Report of Committee, &c, 1815, p. 191. 



WHAT ASYLUMS WERE. 



J09 



pear, as may be supposed, to have been much more success- 
ful in alleviating insanity than the continental receptacles* 
Iberti modestly suggests that this success can easily be ex- 
plained by attending to the eccentricity which distinguishes 
the manners of Englishmen ; and, of course, by drawing the 
obvious inference, that there exists but little difference be- 
tween the sanity of those who are confined in asylums and of 
those who are left at large.* Until the erection of a separ- 
ate building, lunatics were placed in the Edinburgh Infir- 
mary, where twelve cells were set apart for their exclusive 
use, a measure which placed the sick at the mercy of the 
insensate, and exposed the insensate to all the dangers of 
contagion ; and which rendered all attempts to cure mental 
disease ridiculous and impracticable, or if practicable, alto- 
gether nugatory .f In 1818, the same practice wa3 pursued 
at Lyons, and on principles still more objectionable. There 
the lunatic was not permitted to associate with all the in- 
mates indiscriminately ; he was condemned to the society of 
those who were at once loathsome from disease and debased 
by crime. The most wretched and infamous refuse of the 
community mingled with, and, can we avoid supposing, taint- 
ed those who, from their situation, could neither recognize 
nor repel their friendship. 

Previous to 1828, only twelve of the fifty-two counties of 
England possessed public establishments for the insane : 
and, until 1808, there was only one asylum in Ireland, all 
pauper lunatics requiring restraint being necessarily placed 
in the prison or work-house, with the indigent and idle, the 
robber and the murderer.^ And so lax were the laws, that 
serious doubts have arisen whether many of those treated in 
this manner were not altogether free from mental disease, 

* Iberti. Observations Generates sur les Hopitaux, p. 41, 42. 
f History of Infirmary, p. 9. 

X Halliday. General View of the Present State of Lunatics and 
Lunatic Asylums, &c. 1828, p. 13. 



110 WHAT ASYLUMS WERE. 

and sacrificed by malice, revenge, or avarice. The inquiry 
is somewhat foreign to my present purpose : but even the 
suspicion that such an injustice could have been perpetrated, 
illustrates the amount of care and solicitude displayed re- 
specting the subject of insanity. It is, however, necessary 
to make some observations on the distribution and treatment 
of lunatics in such places of detention. In 1807 the gaols in 
England were proved to contain 37, the houses of correc- 
tion 113, and the poorhouses, and houses of industry or 
workhouses, 1765 lunatics.* Even at the present moment, 
127 of the insane poor belonging to the county of Middlesex 
are confined in workhouses.-!- It would be ridiculous to ima- 
gine, that in such receptacles any attempt was, or could be 
made to correct the delusions under which they laboured, 
or even to the physical causes from which these proceeded. 
If an ulcer appeared upon the leg, I shall admit that the 
parish surgeon would exert his experience to heal it, but 
into the mental ulcer he was not called upon to penetrate ; 
nor, had charity or a perfect knowledge of his art prompted 
him to do so, would interference, under such circumstances, 
have been of the slightest avail. No kindness, no ingenuity 
could have triumphed over the series of irritations insepara- 
ble from such a situation. But, although destitute of all the 
means necessary for the subjugation of their disease, there 
is reason to believe, or rather to hope, that so far as food 
and clothing and the comforts which many, even of the most 
degraded lunatics, desire and value, were concerned, they 
were as carefully and plentifully provided for as the other 
inmates. There are, however, some known and appalling 
exceptions to this charitable supposition. Naked patients 
were found chained to the ground night and day, and this 
for a long lapse of years : all water for ablution was denied 

* Report from Select Committee, &c 1807, p. 12. 
•f Sixth Report of the Physician and Treasurer of the Middlesex 
Pauper Lunatic Asylum, 1837. 



WHAT ASYLUMS WERE. Ill 

them : others passed the whole night in cells, where so 
pestilential was the atmosphere, that the inquisitors who de- 
tected these facts could not remain in them for a few minutes, 
" Both of them," avers one of these gentlemen, speaking of two 
lunatics, "were chained down to the damp stone floor, and one 
of them had only a little dirty straw, which appeared to have 
been there for many weeks, — the chain was a long one and 
fastened to the centre, and admitted of her just coming out- 
side where she sat, — she was perfectly quiet and harmless, — 
she was not allowed water to wash herself."* Another witness 
states, u that in a workhouse in his neighbourhood, there is 
a cell which opens outwardly into the yard, but has no com- 
munication internally with the house, and where they have 
no comfort of a fire, — his father knew a person who was 
chained naked, lying on straw for fifty years in a work- 
house."f Still further doubt has been excited as to the 
spirit in which certain workhouses were conducted, by the 
discovery of a traffic of so detestable and revolting charac- 
ter, that the soul sickens at the very name. " In a debate 
in 1815, Mr. Horner, after stating that a gang of factory 
children had been exposed to sale as part of a bankrupt's 
effects, said, " Another case more horrible came to my 
knowledge while on a committee up stairs : that not many 
years ago, an agreement had been made between a London 
parish and a Lancashire manufacturer, by which it was sti- 
pulated, that with every twenty sound children one idiot 
should be taken "% Here, then, in this free and glorious 
land was the foundling idiot sold into servitude : here, in 
this Christian land, and under the pretext of charity, were 
the purposes of benevolence prostituted by the most unwar- 

• First Report of Committee, &c. 1815, p. 55, evidence of Henry 
Alexander, Esq. 

f First Report of Committee, &c p. 124, evidence of Mr. Thomas 
Bakewell. 

X Quarterly Review. Vol. lvii. p. 402. 



H2 WHAT ASYLUMS WERE, 

rantable measures for removing a parish burden, or, I ought 
rather to say, by the most cruel, callous, and systematized 
indifference to human suffering and infirmity, ever recorded. 
Common sense has so far triumphed, that with the excep- 
tion of some poor and remote districts, the grotesque classi- 
fication of the insane with the criminal and the pauper has 
been altogether abandoned in this country. But in some 
parts of the continent, as Hesse and Hanover, the insane still 
are, or very recently were, mixed with criminals, shut up in 
damp cells, the windows of which are unglazed, furnished 
with beds of dirty straw, but perfectly naked. One of the 
most primitive and rude houses of detention exists in the 
vicinity of Venice. On a flat, slimy, and solitary island in 
one of the lagoons, there is a ruin, which, although de- 
serted by rational men as uninhabitable, is conceived to be 
sufficiently good for the degraded maniac. The requisite 
qualities of strength of wall, bars in the loop-holes which ad- 
mit light, and solitude, are certainly not wanting. In the 
lower apartments of this building, which are unfurnished, 
never cleaned, and exposed, from the want of windows, to the 
extremes of temperature, are confined a few madmen nearly 
naked, shockingly filthy ; haggard and half-starved in aspect* 
these men seem to realise the ideas formerly entertained of 
their condition. They are fed once a-day, the food being 
thrown to them through the bars, as carrion is tossed to a 
wolf. The continuance of such barbarity on the very con- 
fines of civilization, may be pardoned ; but how awful the 
responsibility of that government which permitted misman- 
agement nearly as gross to exist at Nantes so late as 1818, 
in the very centre of civilization.* Or what shall we think 
of the following narration? Sir G. O. Paul states, in 1807, 
that he was acquainted with the case of a maniac, who was 
shut up and chained in an uninhabited ruin. His friends 

* Diet, des Sciences Me'd. art. " Maisons des Alienes." 



WHAT ASYLUMS WERE. 113 

resided at some distance, but brought him a daily allowance 
of food.* The darkest chapter in the history of the human 
heart might be compiled from the recorded sufferings of the 
insane. 

Now, I have spoken of prisons being used as asylums; but 
the converse is likewise true, asylums having been used as 
prisons, with this important difference, however, that in the 
latter case the prisoner was guiltless, not even guilty of being 
diseased. In fact, the popular belief that asylums have been 
employed to gratify the cupidity or malice of interested or 
indifferent friends, appears not to be without foundation. 
Men who were sane, or who scarcely displayed a shade of 
eccentricity in their conduct, have been entrapped, impri- 
soned, and confined, in defiance of the most active interfer- 
ence made in their favour. The spirit which gives a clemency 
to the most rigid legal scrutinies, was suppressed ; and the 
presumption, instead of being that the accused should be re- 
garded as sane until he was proved to be deranged, was in- 
variably, that the individual must be treated as mad until he \ 
was proved to be sane. The provisions of the enactment for 
the protection of the rights of those suspected of lunacy, are, 
notwithstanding, ample and adequate. Confinement ought 
not, according to the intention of the original framers of the 
statute, to be resorted to, nor can it be held to be authorized, 
until subsequent to the repeated visits of two medical men 
to the person under suspicion, and until they have given an 
affidavit that such a course is necessary. Practitioners have 
been found so ignorant, or so regardless of their duties to 
their fellow-men, imposed by the exercise of their profession, 
as to sign this solemn attestation, which condemns to depri- 
vation of freedom, and of the rights and privileges of citi- 
zenship, and to separation from home and friends, without I 
having seen the individual against whom such designs are 

* Report of Committee, 1807, p. 21, 



114 WHAT ASYLUMS WERE. 

meditated ; without knowing, except on hearsay evidence, 
whether insanity exists, or insanity to such a degree as to 
justify restraint. The poor are protected from such injustice 
by their very poverty. No one is interested in secluding 
them ; in fact, should selfish feelings predominate, it is the 
interest of the parish upon which they are dependent, and 
by the charities of which they must be supported during 
confinement, to deprive them, when afflicted with insanity, of 
the superintendence of medical men as long as possible. And 
is not this hard-hearted parsimonious policy frequently 
adopted ? Upon the rich falls the violation of this law. The 
act of stealing a man of property, and immuring him for life 
in a dungeon, in this country, appears, at first sight imprac- 
ticable. But there exist strong grounds for believing that 
such a species of kidnapping has been successfully carried 
into effect.* Of the facility with which agents in such a 
scheme may be found, I have personal experience. I was 
employed to obtain medical evidence of the lunacy of a per- 
son who retained reason and cunning sufficient to suspect my 
designs, and had address and means to have eluded them. 
He was attended by a physician of great eminence, who, 
although convinced that his patient was insane, from the 
dread of being dragged into a court of law, refused to parti- 
cipate in the necessary legal steps. To have introduced 
another medical attendant would have excited suspicion, and 
precipitated either the retreat or the suicide of the object of 
my solicitude. From this dilemma, a friend of the patient's 
kindly offered to extricate me, by procuring the signature of 
an individual whom he characterized as of great respectabi- 
lity, and as possessing a reputation for intimate knowledge 
of mental disease. On stating that it would be impossible to 
bring about an interview between the parties, my adviser 
assured me that this form was not necessary, that his friend 

* Pigott on Suicide and its Antidotes, p. 107. Report of Com- 
mittee, &c, 1807, p. 10, 14, 19. Ibid. 1815, p. 124. 



WHAT ASYLUMS WEEK. 115 

would grant the requisite certificate of lunacy without any- 
preliminary investigation, and that he was frequently called 
upon to act in the same manner. That such cases of ab- 
duction and inhumation have taken place, is pretty well esta- 
blished ; that they still occur, is more than suspected. The 
opportunities for confining and concealing sane persons in 
asylums, whether public or private, are very great; and 
while there exist relatives so inhuman as to consign those 
who obstruct their selfish interests or thwart some cherished 
project to such a fate, instruments sufficiently base and in- 
famous will be found to carry their purpose into execution. 
The only safeguard — it does not amount to prevention— 
against such abuses, will be in making all asylums patent, 
not only to the occasional visits and very imperfect scrutiny 
of the legal authorities, but to the constant surveillance of 
humane and trustworthy persons, competent by education 
and character for the duty. 

Some adequate remedy should be provided ; for even to 
the partially unhinged mind there is scarcely within the range 
of human misery an affliction more cruel than such a fate ; I 
to the sane it can scarcely fail to prove the cause of derange- 
ment. There is the uprooting of every affection, — the dis- 
appointment of every hope ; there is the anticipated eternal 
separation from the world, and all its enjoyments and inha- 
bitants, the degradation of caste, and the conviction that all j 
these varieties of bitterness are inflicted by those in whom 
confidence was reposed, who were objects of love, and who 
with the right and power to cherish and protect, have be- , 
trayed their trust by deserting and oppressing. Besides this 
there is to be endured a life of solitude and silence, spent 
amid furious and raving maniacs, without object or pursuit ; 
there is the deprivation of all sympathy ; the being ranked 
and treated as a proud or perverse lunatic, or as a drivelling 
imbecile ; and ultimately there must be endured a death 
which may be solaced by the common charities of humanity, 



U6 WHAT ASYLUMS WERE. 

but which no friend will know of or weep for. Such ideas 
must be suggested to the sane, even to the partially sane 
mind, when the first agitation and terror consequent on con- 
finement have subsided ; and are calculated, as 1 have said, 
to accomplish all that the conspirators desire. 

The victims of persecution in the middle ages were committed 
to oubliettes. Built into the recess of a dungeon, with sufficient 
air and food to protract life, but not to allay suffering, they 
were abandoned to linger on for da}*s and weeks, and, as the 
name implied, were forgotten. I know not on which of these 
demoniac destroyers of their kind, those who eutombed the 
body, or those who entombed the soul, the deepest execra- 
tions should be poured. Human law has no punishment for 
such barbarities ; the Christian heart cannot trust itself in 
condemning their perpetration, in awarding justice to the 
perpetrators. I have spoken at length on this abuse, because 
it is the most awful in its consequences, and because it is the 
most difficult of detection. I have likewise spoken strongly, 
but I trust it has been with a voice of virtuous indignation. 

Closely as the asylums originally erected were assimilated 
to prisons ; the whole array of bolts, bars, chains, muffs, 
collars, and strait-jackets, were deemed some years back in- 
sufficient to afford protection to keepers, and a machine was 
invented, so perfect in its construction and satisfactory in 
its application that it deserves description. I shall convey 
the history of this extraordinary apparatus, and of the oc- 
casion which was conceived to justify such unusual restraint, 
nearly in the words of a witness before the parliamentary 
committee : " William Norris had been confined fourteen 
years ; in consequence of attempting to defend himself from 
what he conceived to be the improper treatment of his keep- 
er, who was a habitual drunkard, and at the time intoxicat- 
ed : he was fastened by a long chain, which, passing through 
a partition, enabled the keeper, by going into the next cell, 
to draw him close to the wall at pleasure : to prevent this, 



WHAT ASYLUMS WERE. 117 

Norris muffled the chain with straw so as to hinder its pass- 
ing through the wall : he was afterwards confined by a stout 
ring rivetted round the neck, from which a short chain pass- 
ed to a ring made to slide upwards or downwards on an up- 
right massive iron bar, more than six feet high, inserted into 
the wall. Round his body a strong iron bar about two inches 
wide was rivetted ; on each side the bar was a circular pro- 
jection, which, being fashioned to, and enclosing each of his 
arms, pinioned them close to his sides. This waist bar was 
secured by two similar bars, which, passing over his shoulders, 
were rivetted to the bars on his shoulders by a double link 
to the waist-bar both before and behind. The iron ring 
round his neck was connected to the bars on his shoulders 
by a double link. From each of these bars another short 
chain passed to the ring on the upright iron bar. He could 
raise himself so as to stand against the wall, or in the pillow 
of his bed in the trough in which he lay ; but it was impos- 
sible for him to advance from the wall on which the iron bar 
was soldered, on account of the shortness of his chains, which 
were only twelve inches long. He could not repose in any 
other position than on his back. His right leg was chained 
to the trough, on which he had remained thus encaged and 
chained for twelve years."* The unfortunate being thus em- 
paled was of great muscular power ; his wrists were formed 
in so peculiar a manner as to render all manacles useless, and 
his disposition is described as blood-thirsty. I presume he 
was affected with homicidal monomania. Notwithstanding 
these very formidable qualities, when we learn that at one 
time he was so docile as to be useful to the servants, that dur- 
ing his incasement in iron he spoke rationally, seemed to 
understand all that was addressed to him, and to recollect all 
that he had suffered : that he occupied his time in reading, 
and that when partially liberated he conducted himself with 

* First Report of Committee, &c. 1S15, p. 12. Evidence of Mr. 
E. Wakefield. 



118 WHAT ASYLUMS WERE. 

propriety; the amount and nature of the precautions adopt- 
ed appears to have been unnecessary and oppressive.* They 
afforded, it is true, adequate protection to all around ; but on 
a mind in such a condition, in a condition so favourable 
for treatment, moral impressions might have been made 
to become, as in cases of a precisely similar kind they 
have become, a source of protection as powerful and as 
permanent ; or, if the patient's nature was really so ferocious 
and irreclaimable as to render all such efforts fruitless ; why 
w r as complete isolation not attempted ? Why, during the 
periods of intelligence and tranquillity, the periods in fact 
when he was no longer dangerous, was there no intermission, 
no diminution of these laboured precautions ? I know no- 
thing at all parallel to this contrivance except a mode of re- 
straint very recently employed at Rome for the turbulent and 
furious. Two iron rings are fixed in the wall of the cell, one 
of these serves as a collar and embraces the neck, the other 
passes round the ankle ; thus united action compels the 
prisoner to stand upright, or, should fatigue and exhaustion 
render that impossible, to hang suspended. t The race of men 
who could thus see no safety but in chains, drew a line of dis- 
tinction as to whom they were to be applied. Patricians, we 
would be led to believe, were calm and tranquil in their 
frenzy, for Dr. Monro states, that under his superintendence 
" gentlemen " were never chained, but that such measures 
were necessary for the poor in public establishments.^ This 
was clearly an error in judgment ; a pernicious mistake, it is 
true., arising out of the opinions prevalent as to the nature. of 
mental disease, and as to the inefficacy of moral treatment : 

* First Report of Minutes, &c., 1816, p. 41. Evidence of Mr. James 
Simmonds. Second Report from Committee, &c, 1815, p. 151. 
Evidence of William Smith, Esq. 

+ Brierre de Boismont. Memoire pour l'Etablissement d'un Hos- 
pice d'Aliene's, Annales d' Hygiene Publique, vol. xvi. p. 104- 

J First Report of Committee, &c, 1 8 15, p. 93. 



WHAT ASYLUMS WERE. 119 

but on advancing one step farther into the inquiry, the same 
timid measures are discovered to have been taken as part of 
a system, not of cure but of economy. To avoid the lavish 
outlay that would be incurred by employing additional keep- 
ers, " It was stated," says Dr. Fowler, " when the keepers 
were asked the reason for putting them in irons, that it would 
require a larger expense than they could afford to keep ser- » 
vants to take care of them if they were not ironed."* 

I have rashly, it may be conceived, compared the former 
treatment of lunatics to that of the animals in a menagerie. 
From motives precisely similar to those which actuate Polito 
or Wombwell, the patients in Bedlam used to be exhibited to 
any one paying four shillings. And that callous and unen- 
lightened curiosity which draws crowds to the one exhibition 
drew crowds to the other. So strong was this feeling that, 
until about sixty years since, a large sum, amounting to about 
L.400 per annum, was raised by this tax.f Throughout 
France, one or two large towns excepted, this detestable prac- 
tice is still persevered in, or, if nominally discontinued, the 
purse always contains a talisman which removes all difficul- 
ties. Esquirol adds that the guardians spare neither menaces 
nor sarcasms in order to rouse the passions of the patients 
for the amusement of the visitors. It is difficult to say who 
shall be admitted and who excluded ; but no rule of admis- 
sion, of whatever latitude, should include visitors for amuse- 
ment. Open to the intelligent and humane as a means of 
preventing or removing those abuses which I denounce, asy- 
lums ought to be closed to the public, and as sacred from 
vulgar unsympathizing eyes as the secrets they so often re- 
veal. Conceive the feelings of a family whose sister, or father, 
or friend, had been made the sport or even the gazing-stock 
of what is, surely in derision, called a party of pleasure ; or, 

* First Report of Committee, &c, 1815, p. 46. 
f Highmore. An account of the various Public Charities in or near 
London, p, 19. 



120 WHAT ASYLUMS WERtf. 

conceive again the feelings of that sister, or father, or friend, 
on returning to the world and encountering those to whom 
their ravings and folly had afforded matter for wonder or 
merriment. The evil consequences of such treatment in a 
medical point of view are glaring, but here it is only neces- 
sary to expose its barbarity and brutality. But we have not 
yet arrived at the climax. It has been insinuated that imbe- 
ciles have been deprived for some time of food, in order to 
astonish the spectators by their voracity when it was given 
to them. This at least is certain, that a miserable creature 
who was in the habit of eating his own excrement, earth and 
filth of every description, was furnished with weeds and grass 
to devour to gratify the curiosity of visitors.* It would be 
•absurd to suppose that this custom of swallowing noxious and 
indigestible substances was in general encouraged for the 
reason here alleged, or for any other. But, in proof of how 
much lunatics have been neglected, it may be mentioned, 
that, in the dissection of the bodies of those known as earth- 
eaters, the colon is sometimes found to be distended with 
earth and clay, and in such enormous quantities that it must 
have been the accumulation of months or even years. This 
I have seen. The gross inattention of governors of asylums 
to the comfort, and of keepers to the helpless condition, of 
those committed to their custody, it cannot be called care, is 
seen in the fact mentioned by Esquirol, that idiots and imbe- 
ciles often lose their limbs from grangrene produced by cold, 
and, shocking to relate, from the attacks of rats. Similar 
accidents used to occur at Bedlam, and Sir A. Halliday states 
that he saw, in this country, a rat devouring the extremities 
of a maniac, who was lying naked on some straw, in the 
agonies of death. f Although inappropriate food is often given 
to lunatics, so far as I know, there is no instance on record 

* Carter. A Short Account of some of the Principal Hospitals of 
Fiance, Italy, Switzerland, &c. p. 42. 
■f Letter in the Courant Newspaper, September 1836. 



WHAT ASYLUMS WERE. 121 

of the supply of food being inadequate in this country. 
The case is different in France. During the sway of the 
revolutionary government, the allowance to the lunatics in 
the public asylums was reduced to the smallest possible 
amount which could sustain life. The most marked and me- 
lancholy results followed. The convalescents relapsed, the 
furious became still more frantic from hunger ; and the 
mortality increased to a frightful degree. Fifty-six patients 
died in one month in Salpetriere ; and in the space of two 
months, the mortality in Bicetre exceeded that of the whole 
previous year, when the rations were liberal. 

In smaller institutions, the evils arising from negligence 
or parsimony are probably still more aggravated. The 
dread of detection is there comparatively slight. Proprietor, 
servants, all may enter into an execrable league to gorge on 
the spoils of the poor and defenceless ; and by whom can the 
conspiracy be traced or defeated ? The lunatic who suffers, 
is not listened to ; the barbarian who oppresses, is at once 
witness and jury. We hear of the wine and spirits which 
the exhausted maniac may be advised to take, being diluted 
or adulterated ; we hear of patients being confined in out- 
houses which were formerly pig-sties, sleeping in cribs so 
small, as to cause permanent contraction of the limbs ; we 
can scarcely picture to the mind three miserable, emaciated 
beings, huddled together in a bed intended for one person, 
without any straw or covering, save a single rug, or coarse 
hop sack : we can scarcely believe, that, in a climate such 
as this, a number of weak and diseased men should be 
compelled to sleep in a damp cellar containing a well. But 
if we once admit and believe these atrocities as possible, we 
can then understand the details of suffering and death from 
mortification and typhus fever, which are given as the con- 
sequence, and the peculation and fraud which are given as 
the cause. This applies chiefly to the want of proper cloth- 
ing. An expose of the system pursued, adds another and 

G 



122 



WHAT ASYLUMS WERE, 



darker shade to the picture I have drawn. The patients are 
represented as furious and destructive, to their friends and 
guardians. It is declared to be impossible to restrain them 
from tearing their clothes, and new supplies are frequently- 
demanded : and the articles thus accumulated are sold, while 
those for whom they were intended sit naked and shivering 
in the cold, without even the solace of heat to mitigate 
their melancholy.* 

The nature of the medical treatment which prevailed in 
this disease previous to 1815, which may he styled the era 
of the reformation, may be judged of from the following 
statements. In a large asylum in England, the superintend- 
ent, who was intrusted with the moral management, as well 
as the direction of the internal economy, sometimes absent- 
ed himself for two months ; in another, containing about 
four hundred patients, no attempt whatever was at any time 
made to restore mental health ; in a third, and that a me- 
tropolitan one, where an immense number of individuals are 
confined, and where the character of the various species of 
lunacy, is as different as the dispositions and temperament 
of these patients, and where every case may be accompanied 
with a different bodily disease, it was an established rule, 
that all, without any reservation, should be bled in June, 
and receive four emetics per annum. -f When the physician 
paid his regular visits, which were " few and far between," 
the patients were arranged in two rows, between which he 
passed rapidly, receiving reports of their complaints at se- 
cond-hand from the apothecary ; prescribing, guided clearly 
by some intuitive knowledge, in this fashion. — " Number one, 
a purge ; number two, an emetic ; number ten, bleeding." 
We are assured by certain high authorities, that insanity is 

* First Report of Minutes, 1816, passim. 

+ First Report of Minutes, &c, 1816; and First Report by Com- 
mittee, 1815, p. 37. 



WHAT ASYLUMS WERE. 123 

the most easily cured of all serious maladies ; and I have at- 
tempted to show, that, under favourable circumstances, it is 
much more easily cured than what was formerly supposed ; 
but such conduct as that now described would force us to 
conclude that the cures are spontaneous, and that Nature, 
in her prodigality of power and affection, rejects altogether 
the assistance of art. In those days, even experienced and 
humane physicians gave their sanction to such an opinion, 
by declaring that medicine was of little importance ; and 
in compliance with these views, there were no baths, no de- 
pletion, no regulation of diet, no interference in fact, further 
than what was demanded for the ailments which sprung 
from this neglect. 

Moral treatment there was none. The mind was left to 
recover its native strength and buoyancy spontaneously. 
All classes of patients were crowded together without occu- 
pation, ec without means," remarks one of their benefactors 
and champions, " being thought of to lead their attention 
from the disturbed objects with which a diseased mind is 
pervaded ; indeed, it struck me that the hospital was much 
more like a lock-up house to confine persons in, than an 
hospital for the cure of disease."* 

Classification was never thought of: criminals, lunatics, 
the furious and the gentle were compelled to live promiscu- 
ously ; nay, the doctrine was gravely promulgated, that it 
ought to be refrained from on principle : the principle being, 
so far as I can understand it, to convince one set of lunatics 
of their insanity, by exposing before them the fury and 
follies of another set. The following quotation may serve as 
a commentary on this text : " In one of these rooms I found 
four and twenty individuals lying, seme old, some infirm, 
one or two dying, some insane, and in the centre of the 

* Evidence of Mr. Ed. Wakefield, First Report, 1816. 



- 



124 WHAT ASYLUMS WERE. 

room was left the corpse of one who died a few hours 
before."* 

If the burden of disease was removed, it was not through 
the instrumentality of any process instituted for the purpose ; 
if it remained, and the mind sunk debilitated and worn out 
under the pressure, no active interference could be blamed 
for accelerating the event. In many instances there existed 
an obvious interest and unequivocal design to protract 
the duration of the disease. The curability of cases at 
that time depended, in many instances, less on the nature 
of the derangement, than the amount of board. Accordingly, 
we find, that where patients were not literally abandoned to 
their fate, whatever curative measures were adopted, have 
more the appearance of being obstacles and impediments to 
the restoration of reason, than of being dictated by common 
humanity, or common sense. The whole superintendence 
was committed to keepers, uneducated, coarse in manners, 
dissolute in morals, often cruel, and always irresponsible. 
It was their duty to administer, nay more, to prescribe baths, 
medicines, restraint, punishment. That which they might 
have done with safety and benefit, and without much in- 
struction, bathing, they neglected ; that, punishment, which, 
if resorted to, requires the nicest discrimination and the 
calmest judgment to prescribe, and to apportion to the of- 
fence, and which almost all men now agree can be entirely 
dispensed with, they inflicted constantly, ignorantly, indis- 
criminately, and in retaliation. The lash, they conceived, 
was ever ready, of easy application, and of instantaneous effi- 
cacy. It is curious, that even the humane Pinel, biassed by 
the opinions and timidity of his coadjutors, and by the spirit 
of the age in which he lived, seemed inclined to admit the 

* Report, Lunatic Poor in Ireland, p. 15. Evidence of Thomaa 
Rice, Esq. 



WHAT ASYLUMS WERE. 



125 



propriety of trying the " excitement of terror " as a remedy. 
You must have heard of individuals being frightened out of 
their senses ; but will not readily credit the statement, that 
attempts have been gravely made to frighten a man into his 
senses. This was evidently the principle and object of those 
who covered the walls of the lunatic's cell with sketches in 
phosphorus, of hobgoblins and hideous figures, so that his 
eye might be arrested by the glare whenever he awoke. But 
in justice to the memory of those who suggested or advo- 
cated this practice, I am bound to state, that it is still per- 
severed in, even by men whose motives cannot be suspected, 
and who declare that benefit has accrued from the applica- 
tion of what is obviously but a modification of the same 
principle. It appears that in the Senavretta at Milan, they 
have constructed an apartment, which can be placed in 
darkness or light, into which the rain can be made to de 
scend, and around which the thunder can be made to peal 
at pleasure.* These sources of terror are directed against 
furious mania. I cannot conceive that much benefit should 
accrue from such a plan. That insanity has been cured by 
means of sudden, and powerful, and sometimes by depressing 
impressions produced by external circumstances, may be ad- 
mitted. But instances of this kind are of rare occurrence, 
have generally been accidental, and of so dubious a charac- 
ter, that it is difficult to determine, whether the joy, or sor- 
row, or other vivid emotion excited, be the cause of the sub- 
sequent recovery, or merely an indication of returning health 
and the last of a series of stages of improvement. If such a 
measure succeed in rousing the fear or superstition of the 
patient, as it fairly may be expected to do, but fail in remov- 
ing the disease, it is highly probable that the mind may be 
totally unhinged, or so deeply injured, as to sink into fatuity, 

* Brierre de Boismont — Annales de Hygiene, torn. xvi. p. 56. 



L26 Wll \T ASYI.IUUS \vi CM . 

orto bailie nil other treatment. This risk is confessedly so 
imminent) that even the surprise bath, the mildest and mosl 
justifiable mode iii which sudden and disagreeable Impres* 
lions could be oommiinioated} has fallen into disrepute, and 
has been in many plaoes altogether abandoned. From these 
statements it is clear, that although this practice may be 
condemned is baiardous and unphilosophical, it cannot, 

in every case, he si i^iual i/ed as cruel. 

Thai you may not imagine that I have made assert ions of 

ihe prevalence of oorpoval punishment rashly, or thai l have 

merely eonelmleil thai such a result was likely to follow eon 
duet, so irreconcilable wit h justice and humanity, two brief 

but striking narratives may be presented to you. A surgeon 

stated in evidence before a ( 'oiimiil lee of I he I louse of ( 'om- 
inous, (hat in \ isiliii", a private asylum, he saw a keeper beat 
Iflg in a most bridal manner a eaplain in the navy, who WSJ 
Confined by means of ft chain on his legS, and hand-cull's, so 

that he could neither escape aor defend himself. Mark the 

import of Ihe concluding sentence : " He died shortly after- 
wards." The same keeper beat another patient, so violently 
with a pair of boots (hat, mark again tin- conse(|uence, lt he 
died shortly afterwards." Now, I most fervently hope thai 
although death untjuesl ionably followed the infliction of 
this horrible cruelly, it was rather in the order of lime than 
of causation. Yet what limits can be assigned, or can e\isl, 
to passion which would give rise to such an accusation as 
the Following : '* 1 have seen her, a keeper, lock her, a 
harmless maniac, down in her crib with wrist-locks and || •<■;- 
locks, and horse-whi|> her: I have seen the blood follow the 
strokes."* This occurred in L81S, and was Ihe result neither 

of in difference nor inhumanity on ihe part of the oonduotor 

Ofthe establishment, but. ol'lhe vicious system then prevalent, 
and especially of thai. most, reprehensible pari of it, which 

* fust Report of Minutes, && i*u>, pp, 2, and 64. 



WHAT ASYLUMS WERE. 127 

consigned the care of the insane to the uneducated and bru- 
tal, to deputies and servants whose chief recommendation 

was a want of delicacy and refinement, and whose onty ob- 
ject was aggrandisement. 

I would be loath, indeed it would be unfair, to take the 
following relation, for the truth of which I can vouch, as il- 
lustrative of the moral treatment formerly pursut d in public 
institutions. A patient affected with satyriasis wasenaM- d, 
either from the relaxed state of morality or discipline i 
ing in the asylum in which he was confined, to gratify his 
desires when he pleased. I lis gallantries were again and 
again discovered, and punished by blows and lasftM so effi- 
cacious, that he was obliged to return to chastity, in order to 
preserve his life. This fact, although not adduced to prove 
that a universal corruption of morals pervaded our asylums, 
does prove two things, first, that the constitution of these was 
so utterly inefficient, so faulty, that smell corruption might 
existed ; and secondly, that the means taken to correct 
this corruption, while characteristic of the time and mode of 
thinking on the subject, were as much worthy the ti 
moral treatment as the whipping of negroes to promote sub- 
ordination and industry. But while I have every disposi- 
tion to avoid establishing the above case as a standard, it 
cannot be denied that gross immorality of a similar descrip- 
tion existed, or rather was sanctioned by the absence of all 
enlightened management, by the selection of improper 
keepers, and by that secrecy and irresponsibility which cha- 
racterised every proceeding within the walls of a madhouse. 
Thus, for example, a female of unimpeachable character be- 
came insane, and exposed, by the nature of her malady, to 
the designs of all around, whether they aimed at the destruc- 
tion of her body or of her virtue, fell a victim to the demo- 
niac passion of one of the keepers to whom she was intrusted 
for protection. In the asylum where this occurred the male 
servants had keys which admitted them to the sleeping rooms 



128 WHAT ASYLUMS WERE. 

of the female patients.* This is unfortunately not a solitary 
instance.f 

Some individuals carry their horror of innovation so far as 
to contemplate with suspicion even the partial overthrow of 
the ancient usages of madhouses. Yet, within the space of 
a few years, and under the very eyes of these persons, so to- 
tal was the disregard of decency, that in some institutions 
every thing was conducted as if there had been no distinction 
of sex. Perhaps the sapient rulers of these imagined that 
the lunatic, in consequence of his or her affliction, lost all 
knowledge of such distinction, or all the shame, or modesty, 
or delicacy which attends such a knowledge. Be this as it 
may, the male and female patients were allowed to mingle 
indiscriminately, and to sleep in the same division of the 
house : indeed, it is somewhat doubtful that even now a se- 
paration has every where been carried into effect, for in 1818 
no attempt of this kind had been made at Montpellier. J The 
unscrupulous liberality which saw no impropriety in such an 
arrangement could scarcely be expected to regulate the tone 
or scrutinize narrowly the decorum and purity of the inter- 
course which ensued. If it be remembered that the beings 
thus having uninterrupted access to each other were irra- 
tional, acting under the impulse of ungovernable passions, 
and unrestrained, perhaps, by the sacred obligations of reli- 
gion, and certainly unmindful of the conventional check of 
public opinion, the extent of the corruption of morals, at all 
events of the deterioration of manners, must have been appall- 
ing. In an asylum, with the private history of which I am 
somewhat acquainted, long after parlours and sleeping wards 
had been provided, a woman continued to sleep in the divi- 
sion of the house appropriated to the men, and to be attended 

* First Report from Committee, &c. 1815, p. 2. 
f First Report of Minutes, &c. 1816, p. 28. 
} Diet, des Sciences Med. art. " Maison d'Alienes." First Report 
of Committee, &c 1815, p. 46. 



WHAT ASYLUMS WERE. 129 

by the male keepers at all times and under all circumstances." 
The pretext for conduct so revolting was, that the individual 
was so violent and powerful as to be unmanageable by- 
females. But the pretext was utterly false, and a betrayal 
of the ignorance and brutality under which those who dared 
to urge it acted. The customs of the present day prove its 
falsity and folly. I have examined many thousands of ma- 
niacs, but I have yet to see one who could not be governed 
or guided by one of her own sex. 

Perhaps the most appalling example of negligence on the 
part of the proprietors of asylums, I do not affirm which has 
occurred, but which has been made public, was detected at 
Fonthill in Wiltshire, by the Parliamentary Commissioners. 
On opening the cells in which the patients lived, they were 
found to be so dirty, and the smell so offensive, as to prevent 
further inspection. Disgusting as I feel the task to be, duty 
compels me to extract the description of one of the victims of 
this savage tyranny : — (i He was confined in one of the ob- 
long troughs, chained down ; he had evidently not been in 
the open air for a considerable time, for when I made them 
bring him out, the man could not endure the light ; he was i 
like an Albino blinking; and they acknowledged that he had / 
not. Upon asking him how often he had been allowed to get / 
out of the trough, he said, ' perhaps once in a week, and / 
sometimes not for a fortnight.' He was not in the least v'io-1 
lent, — he was perfectly calm, and answered the questions 
put to him rationally ; his breathing was so difficult that I 
thought his life likely to be affected by it."f This man was 
confined in an unwholesome cell, measuring nine feet by five. 
Some idea may be formed of the mental capacity, if not of 
the humanity, of the former governors of asylums in this 

* Report from Committee, &c. 1815, p. 93, contains a case some- 
what similar. 

t First Report from Committee, &c, 1815, p. 46. Evidence of Dr. 
Richard Fowler. 



130 WHAT ASYLUMS WERE. 

country, from the statement made by one of them to a Par- 
liamentary Committee, that sleeping cells of 8 feet by 7 are 
as good as those measuring 10 feet 6 inches bj' 8. 

But it is not merely accusations of unjustifiable confine- 
ment, unhealthy cells or arrangements, which threaten life, 
or deprive it of even physical enjoyment, of which I have to 
speak ; charges are on record of systematic cruelty so ex- 
treme, that death was the consequence. The Inquisition 
never told the names or numbers of those who sunk under 
its tortures, or died exhausted under the pestilential atmos- 
phere of its dungeons. The policy of certain asylums appears 
to have been the same. In the report given to the public by 
the superintendents of the York institution, it at one time 
appeared that 221 patients had died. On investigation, the 
actual number was discovered to be 365. What possible 
motive, or rather, what good motive, could suggest such a 
falsification ? Or to put the question in a different form : In 
what way can the deaths of 144 persons thus, for some inte- 
rested purpose, consigned to oblivion, be explained ? But 
this is not all,— .the accusation was more explicit; to quote 
the words of Mr. Higgins : — f( A patient disappears, and is 
never more heard of; he is said to be removed. A patient 
is killed, the body is hurried away, to prevent a coroner's 
inquest."* The human sacrifices of old served as the augur- 
ies of succeeding generations, and from the blood of the un- 
fortunate man here alluded to may be traced that generous 
movement which was made by men of all creeds and parties 
simultaneously, by all those who acknowledged a sympathy 
in the sufferings of their fellow-men, for the purpose of de- 
stroying every remnant of this judicial torture, this legalised 
murder, and of extending protection and aid to the most 
helpless and miserable members of our race. It is not here 
insinuated that all the individuals whose deaths were con- 

* First Report from Committee,[&c, 1815, p. 4. 



WHAT ASYLUMS WERE. 131 

cealed, perished by unfair means, or in any way discreditable 
to their ordinary or medical attendants ; but even after mak- 
ing this admission, and after supposing that this investigation 
was prompted by malicious motives, of which there is not a 
shadow of evidence, will it be believed that grounds could 
exist for accusing the responsible officers of a long established 
asylum, of such crimes as the following ? First, That patients 
were killed by the fury of the keepers, and then reported to 
have died ; secondly, That the real amount of mortality was 
concealed ; thirdly, That no less than 144 deaths took place, 
which were not recorded; fourthly, That in order effectually 
to bur}' these and other malpractices in oblivion, the books 
of the establishment were burned, and false registers substi- 
tuted ; and, lastly, That this attempt failing, the house was 
set fire to and nearly consumed, to the imminent danger of 
all its miserable inmates, and the destruction of at least 
four.* For the honour of our country I would willingly 
believe, that these atrocities may have been too deeply 
coloured, too strongly stated. The charge, however, was 
made by a respectable and benevolent magistrate of the 
county where the circumstances are said to have occurred, 
and is supported by proofs of so clear and convincing a 
kind, that any doubt of the guilt of the parties accused can- 
not be entertained for a moment. 

I have said, that a sweeping charge against all institu- 
tions, as scenes of impurity, profligacy, and cruelty, would 
be unjust. The indictment is sufficiently grave, if it include 
among its counts, total absence of all attempts to secure 
moral, or any other treatment, a callous indifference to the 
comforts, wants, and reasonable wishes of the patients, and 
bigoted perseverance in a system at variance with common 
sense and justice. 

Experiment has shewn in America, that isolation, com- 

* First Report of Committee, &c., 1815. Evidence of Godfrey 
Higgins, Esq., passim. 



132 WHAT ASYLT7MS WERE. 

plete solitary confinement, reduces the convict to madness. 
Had it been designed to secure the continuance of this dis- 
ease in all those afflicted, no better mode could have been 
devised than that formerly pursued towards lunatics. The 
vulgar have an opinion, that those keepers and medical men, 
who have been long associated with lunatics ultimately sink 
under the same disease. So horrible was the system of 
which these persons were the agents, or spectators ; so 
distressing the sufferings which they were condemned to 
witness, or inflict, and so incessant must have been the ex- 
citement of their own passions, that this opinion may have 
been founded in truth. Let us pass a few minutes in an 
asylum as formerly regulated, and from the impression 
made by so brief a visit, let us judge of the effects which 
years, or a life-time spent amid such scenes,, was calculated 
to produce. The building was gloomy, placed in some low, 
confined situation, without windows to the front, every 
chink barred and grated — a perfect gaol. As you enter, 
the creak of bolts, and the clank of chains are scarcely dis- 
tinguishable amid the wild chorus of shrieks and sobs which 
issue from every apartment. The passages are narrow, 
dark, damp, exhale a noxious effluvia, and are provided with 
a door at every two or three yards. Your conductor has 
the head and visage of a Charib ; carries, fit accompaniment, 
a whip and a bunch of keys, and speaks in harsh monosylla- 
bles. The first common room you examine, measuring twelve 
feet long, by seven wide, with a window which does not 
open, is perhaps for females. Ten of them, with no other 
covering than a rag round the waist, are chained to the wall, 
loathsome and hideous ; but, when addressed, evidently re- 
taining some of the intelligence, and much of the feeling 
which in other days ennobled their nature.* In shame or 
sorrow, one of them perhaps utters a cry ; a blow which 

* Report from Committee, &c-, 1815, p. 11. 



WHAT ASYLUMS WERE. 133 

brings the blood from the temple, the tear from the eye, an 
additional chain, a gag, an indecent or contemptuous ex- 
pression, produces silence. And if you ask where these 
creatures sleep, you are led to a kennel eight feet square, 
with an unglazed air-hole eight inches in diameter; in this, 
you are told, five women sleep. The floor is covered, the 
walls bedaubed with filth and excrement; no bedding but wet 
decayed straw is allowed, and the stench is so insupportable, 
that you turn away and hasten from the scene. Each of 
the sombre colours of this picture is a fact. And those facts 
are but a fraction of the evils which have been brought home 
to asylums as they were. 

Doubtless, although the result of these proceedings was 
in every instance inhumanity, they cannot all be traced to 
sheer, gratuitous cruelty — the Moloch propensity to enjoy 
suffering. The motives must have been various. There 
would be the indifference arising from a false hypothesis, 
from the conclusion, that neither benefit nor injury could 
accrue from whatever was done ; the ignorant belief that the 
insane do not and cannot feel the evils heaped upon them ; 
the timid carefulness to prevent escape, destruction of clothes, 
&c. ; the careless sacrifice of the interests and comfort of the 
patient to the temporary accommodation of his attendant ; 
nay, there might even be, for such folly is possible, an ex- 
pectation that bolts and bars, terror and stripes, arc neces- 
sary, and endowed with remedial virtues. The evil of such 
measures was not, however, the less grave, that the views 
upon which they were founded, would not have consigned 
the proposer to the common hangman, or to the milder fate 
of becoming the companion of his victims. No arraign- 
ment, I repeat, is made of the intentions of the curators of 
the insane, but I do arraign the whole system of error which 
they have sanctioned ; I call for a verdict of guilty, and a 
sentence of total subversion, on the pernicious absurdities 
which continue to be practised in their name and authority. 



LECTURE IV. 



WHAT ASYLUMS ARE. 



The old system not altogether exploded — Commencement of the pre- 
sent system — Liberation of lunatics at Bicetre by Pin el — The adop- 
tion of enlightened principles partial, but a desire for improvement 
prevalent— First recognition of humanity and occupation as means of 
treatment in remote times, in Egypt and Belgium — Present mode of 
treatment characterized by want of classification, want of employ- 
ment, want of bodily exercise — Asylums insufficiently heated — Error 
of supposing lunatics impregnable to cold — Inattention to personal 
comfort of lunatics — Corporal punishment professedly abandoned ; 
but cruelty in various forms still committed — Patients confined to 
bed to accommodate servants— Inadequate number of keepers — 
Coercion as a means of cure, of protection — Character and qualifica- 
tions of attendants on Insane — Evils of indiscriminate association of 
insane — No wards for convalescents exist — Grounds for separating 
lunatics— Erroneous views of moral treatment — Night visits — Mental 
anxiety and disturbance produced by the oppressive, harsh, indelicate 
or derisive conduct of keepers — Substitution of convalescent patients 
for keepers — Important duties imposed on this class of servants — 
Difficulty of procuring well-educated persons to undertake such re- 
sponsibility — Exclusion, desertion of friends of lunatics — Asylums 
ill-adapted for reception of rich — Luxurious diet — Indiscriminate 
diet — Solitary meals — Prejudices of public present obstacles to im- 
provement — Examples— How are these to be removed? 

Great improvements have, undoubtedly^ been effected in 
the internal economy of asylums. This result has proceeded 
partly from selfish motives, partly from the prevalence of 
sounder views of the nature and treatment of mental disease, 
and chiefly, so far as the metropolitan establishments are 



WHAT ASYLUMS ARE. 135 

concerned, from the dread of Parliamentary investigations, 
and the surveillance and remonstrances of the medical com- 
missioners. But that we have not altogether escaped from 
the evils characteristic of what asylums were, appears from 
the fact that, so recently as 1828, the Lunatic Hospital at 
Vienna was, according to Burrows, a disgrace to that capital 
and to the era of the nineteenth century ; and from the fol- 
lowing recital, which inpinges more closely on our national 
honour : " In a close room," says Dr. Bright, " in the yard 
two men were shut by an external bolt, and the room was 
remarkably close and offensive. In an outhouse at the bot- 
tom of the yard, ventilated only by cracks in the wall, were 
enclosed three females — the door was padlocked ; upon an 
open rail-bottomed crib herein, without straw, was chained 
a female by the wrists, arms, and legs, and fixed also by 
chains to the crib — her wrists were blistered by the hand- 
cuffs : she was covered only by a rug. The only attendant 
upon all the lunatics appeared to be one female servant, who 
stated she was helped by the patients." n The windows of 
the bedrooms in which the patients pass the night without 
any attendants, are not defended by bars, and the only 
entrance to the men's bedroom is through that occupied by 
the women ; the commissioners went up a staircase said to 
be stopt, and found at the end of it a ruinous room prepared 
with staples for the confinement of any violent patient, &c, 
— an establishment which the commissioners regret they 
have not the power to suppress."* Glad, however, to escape 
from the disgraceful details which occupied the preceding 
Lecture, my present purpose is to describe what is peculiar, 
and especially what is objectionable, in the existing arrange- 
ments, omitting, as much as possible, every thing that appears 
to be and ought to be more characteristic of the system which 
has been unanimously condemned, than of that benevolent 
and rational policy which is now pursued. 

* Report, Pauper Lunatics in Middlesex, &c. 1827, pp. 155-7. 



13*3 WHAT A5YLU5IS ARE. 

Exaggerations have unquestionably crept in, and become 
amalgamated with the rigid bare truth of many of the state 
ments which have been advanced, both as to the past anc 
present condition of the insane. But has the apocryphal nc 
parallel in the accredited history ? Ignorance, — ignoranc< 
alike of all that could and of all that did befall within ar 
asylum lent its aid. Fear, inspired by the unlimited anc 
irresponsible power either conferred by the law, orexercisec 
in defiance of the law by interested friends : inspired by th< 
jealous secrecy of every proceeding which took place subse 
quent to incarceration, by the little that was disclosed, 01 
rather that could not be concealed, of the mysteries of th< 
prison-house, tended powerfully to aggravate the sugi 
of that ignorance. And superstition entered as an ingredien 
into the compound feeling of awe and detestation with whicl 
all that related to the treatment of the insane was regardec 
and interpreted. A similar combination of ill-directed cu 

and suspicion has converted the apothecary 
into a den of mercenary murder, and the medicine then 
vended into the exuviae, the pharmaceutically 6. 

of humanity. 
The cry of the lunatic uttered in the exuberance of hii 

rlf-inflicted anguish, or while writhing under the terror* 
me self-created misfortune, may often have been con 
5trued into expressions of bodily pain proceeding fron 
castigation, or from some other device of that gratuitou; 
cruelty which takes a delight in suffering. In like manner 
as many lunatics, the cunning and suspicious for example 
are as capable of telling, and are as much disposed to tell 
falsehoods as their more responsible fellow-men, and as thej 
are certainly more strongly tempted to make out as favour 
able a case in their own behalf as possible, many 
complaints of hard 1 -tripes, and chains, and starva 

tion, which have reached and been received by the world 
merit no other title than that of sheer fabrications. Butaftei 



WHAT ASYLUMS ARE. 137 

ample allowance has been made for such cases, after deduct- 
ing for the credulity of mankind, and for the fictions which 
an occasional discovery of actual inhumanity might give 
rise to, the question still remains to be answered, is there 
any case which ignorance, or fear, or superstition has con- 
jured up or blackened with their own sombre colouring, 
one-half so gross and revolting as those which have been 
proved by evidence which cannot be disputed ? Is there any 
fiction, cunningly devised in the mind of the insane prisoner 
panting for liberation, at all to be compared with those facts 
which have been seen and recorded by men who had no 
motive but mercy, no objects in view but justice? 

An affecting picture has been drawn of the exhumation, — 
it deserves no other name, of the prisoners from the Bastile, 
and of the liberation of the condemned from the Abbaye on 
the death of Robespierre. But the moral interest of these 
events is equalled by the scene which signalized the appoint- 
ment of Pinel as physician to Bicetre. The gaols used to be 
thrown open on the accession of a new sovereign ; the assump- 
tion of office by this friend to human nature was attended by 
a similar triumph. It was a jubilee initiative of the reign of 
mercy. Eighty lunatics who had long been galled by chains 
were set at liberty. And it is mentioned that the very act 
of liberation, affecting the mind as other powerful impres- 
sions, restored many of them to tranquillity, if not to sanity. 
" The first man on whom the experiment was to be tried," 
says the narrator of the scene, " was an English captain, 
whose history no one knows, as he had been in chains forty 
years. He was thought to be one of the most furious 
amongst them ; his keepers approached him with caution, as 
he had in a fit of fury killed one of them on the spot with a 
blow from his manacles. He was chained more rigorously 
than any of the others. Pinel entered his cell unattended, 
and calmly said to him, ' Captain, I will order your chains 
to be taken off, and give you liberty to walk in the court; if 



138 WHAT ASYLUMS ARE. 

you will promise me to behave well and injure no one.' 
* Yes,' I promise you/ said the maniac ; * but you are laugh- 
ing at me ; you are all too much afraid of me.' ' I have six 
men/ answered Pinel, ' ready to enforce my commands if 
necessary. Believe me then, on my word, I will give you 
your liberty if you will put on this waistcoat.' He submitted 
to this willingly, without a word ; his chains were removed, 
and the keepers retired, leaving the door of his cell open. 
He raised himself many times from his seat, but fell again 
on it, for he had been in a sitting posture so long that he had 
lost the use of his legs ; in a quarter of an hour he succeeded 
in maintaining his balance, and with tottering steps came to 
the door of his dark cell. His first look was at the sky, and 
he cried out enthusiastically, ' How beautiful !' During the 
rest of the day he was constantly in motion, walking up and 
down the stair-cases, and uttering short exclamations of de- 
light. In the evening he returned of his own accord into his 
cell, where a better bed than he had been accustomed to had 
been prepared for him, and he slept tranquilly. During the 
two succeeding years which he spent in the Bicetre, he had 
no return of his previous paroxysms, but even rendered 
himself useful by exercising a kind of authority over the in- 
sane patients whom he ruled in his own fashion."* 

From this period, 1792, may be dated a total revolution 
in the opinions of medical men and legislators, respecting 
the insane, and in the principles upon which houses of de- 
tention are professed to be conducted. The application of 
these views has been tardy ; but, from aiming merely at safe 
custody, the ambition of the humane and philosophic, at 
least, has extended to the employment of means which pro- 
mise to restore a proportion of those confined, to their places 
and duties in society, and to reconcile the remainder to their 
captivity. From a blind and hard-hearted policy, which 

* The British and Foreign Medical Review, No. I. p. 286. Traits' 
Complet du Regime Sanitaire des Alienes, p. 57. 



WHAT ASYLUMS ARE. 139 

embraced only the prevention of one evil by the infliction 
of another, and which, to accomplish this end— amounting 
in plain terms, to nothing more than the preservation of the 
public peace — sacrificed every tie of justice, charity, and 
human fellowship ; a sudden transition was made to a sys- 
tem, professing to be based on a knowledge of the human 
mind, and on the common sympathies of our nature, and 
to have for its object the eradication, or if that appeared 
Utopian, the amelioration of the evil. From darkness they 
passed into light — from savage ferocity into Christian bene- 
volence. These terms are energetic ; but the change which 
they commemorate was so momentous, as to deserve to be 
so characterized. Yet no one must conclude that the views 
from which it proceeded, or the consequences to which it 
led, either realized what subsequent experience has proved 
to be sound and necessary, or completely harmonized with 
what judgment and conscientiousness would dictate. The 
promised land was in sight ; it was not reached. Vast and 
manifest improvements even now require to be made on the 
very soil of which Pinel was the cultivator; and although a 
kindred spirit has succeeded to rear if not to reap the har- 
vest, many years must roll on, and many changes intervene, 
before it arrive at maturity. Unfortunately, every country 
has not possessed a Pinel. The impulse of the reformation 
which he began has been felt, it is true, less or more, in 
every civilized country ; but it has succeeded at certain 
points only, in shaking the strongholds of prejudice and 
ignorance. The change is still one of degree ; for no where 
has it been radical and complete. Even in those favoured 
spots where the greatest care, and the greatest treasure have 
been lavished, there exist organic evils, which nothing but 
a more extended acquaintance with the moral constitution 
of man can remedy. It will not readily be believed, that 
in the country which has produced such men as Guislain, a 
man, supposed to be labouring under hydrophobia, should 






140 WHAT ASYLUMS ARE. 

be confined for two days in a cell,, without assistance or treat- 
ment, and ultimately should be allowed, in the presence of 
the whole medical staff of the hospital, to beat out his brains 
by running against the stove apparently urged to such a 
desperate act, rather by the mania of fear, than by the ago- 
nies of canine madness. It may be said that the cause of 
the lunatic has been eloquently pleaded at the bar of public 
opinion, but that the court has not yet pronounced judg- 
ment. 

There is this characteristic feature in the present condition 
of asylums : — Those to whose care they are entrusted, are 
completely aware of the errors formerly committed, and of 
the grievous injustice which they or their predecessors may 
have been unwittingly perpetrating. Universally a decided 
change is contemplated and desired, and the din of prepara- 
tion is heard wherever isolation is attempted. Good must 
accrue from the opinions that prevail ; and the only ground 
for apprehension which exists, is, that from the want of a 
just estimate of the healthy and diseased states of the mind, 
all the good may not be secured which in other circum- 
stances would be perfectly practicable. For example, in 
many modern institutions, where every anxiety is displayed 
to promote the happiness and comfort of the inmates, the 
same plan of moral treatment, the same enjoyments, the 
same diet, are prescribed for all indiscriminately. It would 
be as rational to treat common cold and consumption by 
the same means, because they both attack the same organ. 
The intention in this instance, is unquestionably to pro- 
duce pleasure ; but it is benevolence acting without the 
guidance of reason, which, for a momentary gratification, 
forfeits the chances of recovery. Notwithstanding this, and 
many similar inconsistencies and errors, which future phi- 
losophers will perceive and correct, the movement which 
commenced at the era alluded to, has produced incalculable 
benefit, and tends towards still greater improvement. 



WHAT ASYLUMS ARE. l4l 

The present system is imperfect, and falls short of a stand- 
ard which is evidently attainable, chiefly because it is not 
founded on, or regulated by any broad or practical philoso- 
phical principle. Glimpses of truth occasionally break in 
upon the minds of those who are the guardians of the lunatic, 
and changes are effected in accordance with the discovery. 
But no grand attempt has been made to place every part of 
the treatment in harmony with his condition. We must not 
quarrel, however, with great ameliorations, although they 
flow from sources less exalted than what the sanguine might 
desire. 

Two of the earliest and most striking departures from the 
time-sanctified system of force, are to be traced to the sub- 
stitution of a system of imposture. So much evil has been 
inflicted on man by superstition, that it is difficult to sup- 
pose it contributing to his happiness. The same principle 
which struggles to keep the mind in ignorance, seems, in 
these instances, to have desired to keep it in peace, and to 
restore to it intelligence. The first example of the com- 
patibility of these objects is found in Egypt, where the most 
enlightened views of modern science are recorded to have 
been engrafted upon the darkest and most degrading forms 
of ancient superstition. The temples dedicated to Saturn 
were literally asylums of the best description. The inten- 
tion of the priest was to enhance the popularity of the deity 
of whom he. was the servant ; and his mode of effecting this 
was founded upon a profound insight into the mechanism of 
the being he designed to repair. He knew the boundless 
credulity of his patients ; and to gratify this feeling, while 
he used it as a powerful agent in giving efficacy to all sub- 
sequent treatment, he declared that the cure about to be 
performed was miraculous, and by the direct intervention 
of his tutelar god. Having established this belief, recourse 
was next had to all those means which a knowledge of mind 
has shewn to be most conducive to restore its originaj tone 



142 WHAT ASYLUMS ARE. 

and strength. Every new moral prescription was not, how- 
ever, exhibited as a medicine, but as a formula of worship, 
revealed by the benevolent member of the polytheism who 
directed his energies to renovate the melancholic and the mad- 
man. Under this guise, the crowds which frequented these 
shrines were engaged in every healthful and amusing exer- 
cise ; they were required to walk in the beautiful gardens 
which surrounded the temples, or to row on the majestic 
Nile. Delightful excursions were planned for them under 
the plea of pilgrimages. Dances, concerts, and comic re- 
presentations, occupied a part of the day, as constituting 
the symbolical worship of some divinity. In short, a series 
of powerful, yet pleasing impressions were communicated at 
a time, and under circumstances, when the feelings were in- 
spired with the most extravagant hope, and with perfect reliance 
upon the power whose pity every act was intended to pro- 
pitiate. The priests triumphed, and deserved to triumph. 
The disease was subdued, and their reputation rose in pro- 
portion. We cannot determine whether they trusted chiefly 
to the mere will of Saturn, or to the discipline he had the 
credit of suggesting ; or whether they believed at all in the 
delusion which they propagated ; nor is it material to know. 
The simple fact of the employment of such means is suf- 
ficient to shew that exercise, occupation, and feelings of 
enjoyment, were considered essentially contributive to the 
efficacy of the miraculous interposition, if such was believed 
to exist.* 

The second example is drawn from a more recent period, 
and is even more open to the suspicion of deception. The 
village of Gheel, now attached to the asylum in Antwerp, 
has long been celebrated as a retreat for lunatics. The 
patients are boarded with the peasants, who employ them 
in their gardens or fields. When unengaged, they are 

* Voisin, Des Causes Morales et Physiques des Maladies Mentales, 
p. 411. 



WHAT ASYLUMS ARE. 143 

permitted to roam about at perfect liberty, and neither 
accidents nor escapes are ever heard of. The labour is 
compulsory, but is regulated according to the strength and 
condition of the workman. The benefits which generally 
accrue from air, exercise, and occupation, are considered as 
of little avail in removing the disease, unless the patients 
regularly once a-day pass under the tomb of a certain St. 
Dymph, to whose sanctity, relics, and good offices, the re- 
storation is solely attributable.* The ashes of this holy 
personage constitute the riches of the place. The physi- 
cians of Belgium may be sceptical of the virtue of these 
relics, but they appear still to avail themselves of the respect 
and confidence with which they are regarded by the lower 
orders. Such a combination of work and penance is ad- 
mirably suited to the character of a people in whom the 
religious are the predominating feelings, and with whose 
most ordinary and trivial transactions the ritual of the 
Romish church is constantly interwoven. The cause which 
produced these changes in a remote age, has led to the im- 
provements which we claim as peculiar to the present. 

From the absence of any common design in the alterations 
which have taken place in the mode of conducting asylums, 
and from the want of similarity in the alterations themselves, 
no description can be attempted which would prove gene- 
rally applicable ; so that my remarks must be classified into 
statements of the excellencies and of the evils which attach to 
the present condition of such establishments, particularizing 
such countries or individual asylums as afford illustrations of 
the one or of the other, but excluding from the investigation 
those cases in which a maximum degree of improvement has 
been attained, as properly belonging to the view of what 
asylums ought to be. 

Much of the present system may be described by nega- 

* Diet, des Sciences Me'd. Carter, Short Account of Principal 
Hospitals, &c. p. 191. 



144 WHAT ASYLUMS ARE. 

tives. There is no classification, no employment, no exercise. 
If you pass through an establishment, all may be tranquil, 
orderly, and humane, but the inmates are lethargically 
slumbering on chairs, or endeavouring to devise occupation 
by tormenting their fellows, or circumventing their keeper. 
Men have been proved to have remained seated in the same 
spot, during the day, for a dozen years, without an attempt 
being made to rouse their muscular or mental energies. 
This species of negligence is often presented in a more 
hideous form. Patients who at first are perfectly able to 
walk, are allowed to remain in bed ; their limbs waste, con- 
tract, are partially anchylosed, and they ultimately become 
unable to rise. A contagious disease broke out in a small 
asylum ; one-half of the patients died ; the bodies having 
been carried to a public hospital, were inspected. In doing 
this, numbers were found to have contracted limbs — a de- 
formity which was traced to the practice to which I have 
alluded ; the position being, in all probability, originally as- 
sumed and retained in order to obtain as great a degree of 
warmth as possible. 

Where peculation no longer exists, and where the lunatic 
is comfortably lodged and sufficiently clothed, there is still 
great inattention to the mode in which the building where 
he sleeps is heated. In winter he is compelled to pass, as if 
in imitation of a Russian bath, from the temperature of a 
crowded and probably over- heated common hall, to that of 
a damp cell which has been cooled down by the indispensable 
process of ventilation, to the freezing point. The cruel fallacy 
that lunatics are insensible to cold and to other modifications 
of pain, has long been acted upon. This error is counte- 
nanced by three circumstances. First, In cases of acute 
mania, from the state of the circulation there actually is 
much heat developed at the surface ; secondly, In another 
class of cases there does exist a degree of insensibility to 
external circumstances ; and, thirdly, Lunatics rarely tell 



WHAT ASYLUMS ARE. 145 

their sufferings. But in these as in all other cases the de- 
pressing influence of cold must and does produce its usual 
consequences. 

Although we have passed the period when cruelty was 
avowed and defended, if not actually prescribed, the spirit 
characteristic of that period has, in some cases, been perpe- 
tuated by avarice. Acts of oppression have been perpetrated 
in defiance of a parliamentary commission, expressly ap- 
pointed to detect and report such offences., which are worthy 
of a darker age. One of these will suffice. In 1820, the 
Commissioners found a patient in a private institution alone 
in an out-house, without a fire — the visit was paid in winter 
— the windows were broken, probably by his own act. He 
was without shoes, but was in other respects sufficiently 
clothed. After much prevarication and deception, it was 
proved that this patient did not sleep in the apartment said 
to be his, but in a miserable room up a private stair, con- 
cealed by a door, which was discovered with considerable 
difficulty. It was a single room, small and offensive, con- 
taining only a wet and dirty piece of sacking filled with 
straw, with one rug and a blanket. For this treatment the 
patient paid L.50 per annum.* 

One great revolution has been consummated, as a conces- 
sion to public opinion ; slowly and reluctantly, but univer- 
sally : one which every man can appreciate and applaud who 
has a spark of benevolence in his composition, and whether 
he understands the detrimental tendency of the former prac- 
tice or not. Corporeal punishment has been professedly 
abandoned. The lash is not openly seen, or recommended 
as a medical instrument. That no cruelty is inflicted under 
the ridiculous name of punishment, or the more specious 
pretext of preserving order, it would be vain to expect ; but 
the infliction is no longer acknowledged. The perpetrators 

* Report, Pauper Lunatics in Middlesex, p. 158, 1827. 

H 



^ 



? 



146 WHAT ASYLUMS ARE. 

shrink from, repudiate and conceal those deeds, in which a 
few years back, if they did not absolutely glory, they at least 
perceived no evil. The first object, then, is gained ; cruelty 
is denounced as iniquitous and unnecessary. The next step 
is' to shew that it is inconsistent with the personal interest of 
those who are empowered to care for and cure the insane. 
Were men generally actuated by pure and exalted motives, 
it would be superfluous to advance further than an exposi- 
tion of the anti-christian spirit of the system : but seeing 
that they are not so actuated, the conviction must be im- 
pressed upon their minds, that it is inefficacious in eradica- 
ting or alleviating mental disease, and that it is inimical, 
even fatal, to the reputation of all institutious where it is 
sttpposed to be resorted to. That acts of cruelty are still 
committed does not admit of doubt. They are less frequent 
and less severe, but they have not ceased. But although 
physical suffering be no longer inflicted, or inflicted to the 
same extent, there are other species of harshness, nay, of 
positive inhumanity, as repugnant to common sense and 
common benevolence. Coercion is employed unnecessarily. 
Either from the savage philosophy of terrifying into obe- 
dience, and, it is to be presumed, into the possession of rea- 
son, or from the despicable economy of employing a small 
corps of keepers ; chains, muffs, manacles, are in many places 
the substitutes for mildness and prudence, or suitable attend- 
ance. Not only the violent and the destructive but the 
perverse, even the restless and noisy maniac must be secured, 
I presume for the preservation of order ; but that the keeper 
may have more time to dispose of for his own amusement, 
the same horrible practice is adopted. In fact, that he may 
have freedom, they must be deprived of it. " I once," says 
Tuke, " visited a house for insane persons, in which security 
was a primary object. Here I saw three of the keepers, in 
the middle of the day earnestly employed in — playing cards."* 

* Description of the Retreat at York, &c-, p. 107. 



WHAT ASYLUMS ARE. 147 

A refinement upon the old mode of economizing the labours 
of keepers has been brought to light by the investigations of 
the Commissioners. The patients were compelled to remain 
in bed, or, as the terms of the justification run, were allowed 
to remain in bed during the whole of Sunday, in order that 
the servants of the establishment might visit their friends.* 
It is possible that the wishes of the patients themselves sug- 
gested this practice ; but the gratifications of such desires 
would convert every day into one of rest and sleep, and 
sacrifice the interests of ultimate restoration to lethargy or 
whim. One of the excuses for resorting to such expedients, 
and for keeping a number of miserable creatures in chains, 
darkness, and filth, for thirty-six hours, was the small num- 
ber of keepers employed. The reason was, in one point of 
view, valid. Servants so engaged are often timid, although 
otherwise well-disposed, and seek for protection : or they 
become depressed and gloomy, contaminated by the atmo- 
sphere in which they move, and seek for intervals of liberty 
as a relief. And unless actuated by a high sense of duty, 
they will not hesitate to obtain these objects, if the attain- 
ment does not lead to a glaring dereliction of duty. They, 
more than any other class of servants, undoubtedly require 
periods of relaxation ; and the way to remove all temptation to 
obtain these by compromising the interests of the patients, is to 
have a large body employed. It appears that in one instance 
three keepers were expected to guide, govern and soothe 
250 patients. In another asylum, 164 patients were intrusted 
to two keepers. In a third, each servant was appointed to 
take charge of 50 patients. The proportion usually is one 
keeper for 30 lunatics. This means that one man or woman 
is to attend to all the wants and wishes, regulate the employ- 
ments and amusements, counsel, tranquillize, walk and con- 
verse with, feed, clothe, and put to bed thirty persons, every 

* Report, Pauper Lunatics in Middlesex, &c-, pp. 22, 30, 37, 90, 
1C9, &c. 1837. 



148 WHAT ASYLUMS ARE. 

one of whom displays a different form of insanity, is furious 
or fatuous, malicious or melancholy. The proposal is alto- 
gether preposterous. Formerly every female keeper in 
Bethlem had sixty patients under her care. This state of 
things is strongly contrasted with the law on the subject in 
France, which accords one keeper for every ten lunatics. 

To return to the subject of restraint. That there are some 
lunatics so completely stript of the attributes of intelligence 
and moral feeling, as neither to perceive nor to suffer from 
the galling thongs with which they are bound, is true. Such 
are the fatuous and imbecile, in whom every power more 
elevated than the impressions of hunger and thirst is oblite- 
rated, and where no restraint is demanded. But such cases, 
eVen when including those of furious maniacs, who are so 
pre-occupied by some engrossing emotion as to be insensible 
to every external circumstance, are rare, when compared 
with the numbers of timid maniacs whose energies are for 
ever paralyzed ; of irascible maniacs whose feelings of anger 
and opposition are roused to a whirlwind of passion ; and of 
proud maniacs, whose innocent arrogance is needlessly 
wounded by the badges of moral slavery. There is now no 
ground for retaining this practice as a means of cure. As a 
source of protection it is sometimes indispensable : on all 
other pretexts it is cruel and oppressive. Even when una- 
voidable it may be deprived of some of its horrors : the 
appearance of force may be concealed : the apparatus may 
be of the least repulsive description, and for bodily coercion, 
confinement to a private room, classification, or permanent 
isolation may be substituted. The best and most humane 
judge of the mutual rights and relations of madmen and 
their keepers, Esquirol, has said that the only estimate which 
can be formed of the character of a house of detention, must 
be founded on the number of individuals actually coerced. 
And this estimate applies not merely to the general gentle- 
ness, but to the efficacy of the treatment pursued. Bu$ 



WHAT ASYLUMS ARE. 149 

although coercion is less resorted to, the adoption of the 
opposite method is slow, reluctant and partial. Not many- 
years have elapsed since in one hall of an asylum, of very 
recent erection, not fewer than eighteen out of twenty-seven 
male patients were chained, muffed, or strapped to their 
seats. A keeper, when first intrusted with these men, was 
cautioned that his life would not be safe for an instant unless 
he adhered to the plan then existing. A brighter destiny lias 
dawned upon these unfortunate beings. In the very same 
hall, containing the same number of persons and many of 
the same individuals, there is not now more than one requir- 
ing restraint. 

The mere conviction that surveillance exists, that they are 
watched and distrusted, is sufficiently painful to the self- re- 
spect and sense of honour which many lunatics cherish, 
without the degradation, — for to minds so constituted it must 
appear degradation, — of personal thraldom. When violence 
or disobedience is displayed, it is never supposed that there 
are any other modes of controlling these than by brute 
force. A common axiom inculcates, that to obtain confidence 
it is necessary to confide. But all common axioms are set 
at nought in an asylum. Xo effort is made to act upon the 
sentiments of probity, or love of approbation, which are as 
strong, cet. par. in the insane as in the sane mind ; and what 
might be obtained by a promise, by an appeal to honour, or 
by some well-chosen expression of admiration, is extorted by 
a command or a chain. 

The frequency with which restraint is even justifiably im- 
posed, depends, in a great measure, upon the immediate 
attendants of the insane. And, unfortunately, this tremen- 
dous power is too often confided to men altogether unworthy 
of the trust. The labours of such a situation are great, 
varied, and of the most delicate nature. They are not, or 
ought not to be limited to the administration of food, atten- 
tion to cleanliness, or the prevention of escape, but should 



150 WHAT ASYLUMS ARE. 

extend to the task of arousing and engaging such of the 
faculties of the patients as still remain healthy, of amusing 
or occupying all who are susceptible of such impressions — 
of soothing the irritable and captious— of inspiring the des- 
ponding with hope — of presenting to all, such objects as are 
calculated to communicate present enjoyment, and to re- 
store the current of thought to its ordinary channels. Such 
ministrations comprise a moral treatment of the most ex- 
tended and exquisite form. Yet to carry this into execution, 
to set this complicated machinery in motion, who are the 
persons, and what their standing and acquirements who are 
employed? Do they possess natural talents or education 
sufficient to perceive and to adapt their own behaviour to 
the dispositions of those whom they are appointed to attend ? 
Have they any knowledge of the human mind in its strength 
or in its decay ; or are they even instructed in the routine 
of duties which devolve upon those who have to superintend 
the personal comforts of twenty or thirty men ? Are they 
in general distinguished for patience, kindness, or those 
conciliating manners which secure the affections, and through 
them the obedience or friendly co-operation of all who come 
within their influence. To not one of these qualifications 
has the great majority of servants in asylums the slightest 
pretension. To shew the ideas entertained by such person- 
ages of insanity, one fact may suffice. The superintendent of 
a public asylum, on paying his forenoon visit, found one of the 
patients, and one subject to frequent fits of excitement, poised 
upon his head. The keeper was seated by the fire, reading ; 
and on being questioned as to the meaning of the scene, re- 
plied, " O, Mr. D. is perfectly quiet ; he has been standing 
on his head for the last half hour !" From the lowness of 
the wages, and the difficult and sometimes dangerous duties 
exacted, such servants are often of the very worst caste ; I 
mean, of course, the worst adapted for such an office. They 
are hired for the express purpose of acting as spies or watch- 



WHAT ASYLUMS ARE. 151 

men, and they aspire to no higher sphere of utility. Coarse 
and uneducated, their presence is offensive to all individuals, 
either of polished mind or manners, or who have been ac- 
customed to attendants of a better grade ; and their society 
can be of no use, even if it be agreeable, to those who might 
be soothed by compassion and affability, or improved by 
intercourse with a person who could understand, and couU 
direct to better objects, the distempered fancies under which 
they labour. Keepers are the unemployed of other profes- 
sions. If they possess physical strength, and a tolerable 
reputation for sobriety, it is enough; and the latter quality 
is frequently dispensed with. They enter upon their duties 
altogether ignorant of what insanity is, fully impressed with 
the idea that the creatures committed to their charge are no 
longer men, that they are incapable of reasoning or feeling, 
and that in order to rule or manage, it is necessary to terrify 
and coerce them. They may not be devoid of good temper, or 
active kindness ; but from their inability to employ these 
agents, and often from a belief that it is contrary to rule to 
employ them, they will be found to punish, domineer, and 
restrain, to the same degree as if actually cruel and tyran- .. 
nical. The physician who has trained his powers for a life 
time, in penetrating into the depths of the diseased mind, 
and who, with all the assistance derived from such experi- 
ence, from the views and observations of others, and from 
the tranquillity and benevolence of manner which he has 
learned to assume, should it not originally be his own ; 
often — how often, let the candid say — fails signally in de- 
tecting the prevailing sentiments, in pacifying, in bending 
to or from a certain purpose, in rendering happy. Yet, in 
modern asylums, a similar course devolves upon the class of 
persons of whom we have spoken ; and who, if they do not 
shrink from the responsibility which they incur, ought to 
pursue it unflinchingly and unceasingly. From the indi- 
viduals who, at present, occupy such situations, it would be 



152 WHAT ASYLUMS ARE. 

absurd to expect any co-operation of this kind. Until man- 
kind perceive that it is as necessary that he who undertakes 
to assist in improving the condition of the insane, should be 
instructed in the mode of doing so, as he who professes to 
improve the condition of the soil — all that can be expected 
is a capability of securing the affections of the patients, and 
a docility in promoting the plans suggested by others. 
i( Your first attempt," I was once told, iC ought to be to cure 
your keepers ; you need not proceed to your patients until 
you have done so." Apart from the necessity of preserving 
order, there is a necessity for the presence of a number of 
this class of servants, arising out of the obvious evil of con- 
lining a lunatic among lunatics. This evil, which is, of 
course, unavoidable, may be materially mitigated, first, by 
the introduction of keepers of strong, healthy, well-con- 
stituted minds: secondly, by possessing ample means of 
classification ; and, thirdly, by the exercise of sound discre- 
tion in the selection of those who are to associate together. 
The disposition, rather than the rate of board, should be the 
principle of this choice. The magnitude of the error com- 
mitted, in banding together a crowd of lunatics in the same 
hall, without any reference to the extent or form of their 
malady, may be gathered from the feelings of horror and 
distraction excited in a perfectly unimpaired mind, on com- 
ing into abrupt contact with the heterogeneous inmates of an 
asylum ; or it may be more strikingly illustrated by the 
pernicious consequences arising from the indiscriminate 
intercourse permitted in prisons. How can the already 
insecure and tottering intellect fail to be shaken by the 
ribaldries, the ravings, the delusions which assail it from all 
sides ? Or how can healthy impressions be received in such 
an infected region ? Besides the constant excitement, the 
trepidation, the sentiment of disgrace or disgust which must 
be produced, positively new delusions may be suggested by 
this intercommunion, and so successfully engrafted, as to 



WHAT ASYLUMS ARE. 153 

supplant those originally characteristic of the disease. An 
example of this was recently under my care. A woman 
believed herself to be our Saviour ; and so excellent a prose- 
lytizer was she, that she completely convinced one of her 
fellow-patients of the truth of her pretensions, and so far 
staggered another by relations of miracles, visions, and so 
forth, as to induce her, occasionally, to acknowledge the 
divinity claimed. Intercourse with healthy minds is, in fact, 
indispensable ; and at such stages of the disease as permit 
of the experiment, the greater the extent to which it is tried 
the better. The visits even of strangers is often beneficial, 
by interrupting the chain of morbid fancies, by arousing 
feelings long dead or dormant, and by re-establishing that 
bond of connection with the external world and its affairs, 
which lunatics often conceive, and often conceive with rea- 
son, is dissevered. Were a regular system, founded on such 
views, instituted and carried into operation by persons pro- 
perly qualified, the benefit might be expected to be great 
and permanent. A practice somewhat similar to that here 
recommended, at one time received the sanction of the di- 
rectors of the Retreat at York, but it does not appear to have 
been pursued to its legitimate extent.* Indeed, with its full 
application the timidity and prejudices of the public, from 
whom, under such circumstances, must arise the voluntary 
moral physicians, will, for a long period, it is to be feared, 
interfere with such outpourings of humanity, or direct them 
into channels widely different. Various expedients may be 
had recourse to in order to supply the deficiency. One of 
these is to take advantage of the different forms and degrees 
of alienation, and to employ him who is gentle and good- 
tempered to take charge of him who is habitually irritable 
and unruly, or to induce the partially insane, he who is 
irrational ten degrees, to associate with, and teach him who 

* Tuke. Description of the Retreat, &c. 



154 What asylums are. 

is irrational twenty degrees. I have been informed that this 
principle is acted upon in the excellent asylum at Perth. To 
apply such a plan upon a grand scale would require great 
delicacy in the anatysis of character : but if this be stated as 
an objection it equally attacks the very foundation of mental 
medicine. 

If it be true that the lunatic at the incursion of the disease 
maybe injured, his cure retarded or prevented, by injudici- 
ously consigning him to the society of those whose deportment 
must disturb or confuse, it will still less admit of question that 
at the period of convalescence, the same danger must exist 
and be felt in tenfold measure. The ease with which relapses 
may be induced, the trifles which induce them are known to 
all : but the knowledge has but in few instances led to any 
provision by which the exciting causes, existing in hospitals, 
may be removed. No separation takes place of those who 
are recovering from those who are lapsing, or have already 
fallen into a state of confirmed insanity. Even subsequent to 
the complete restoration to health, and during the interval of 
probation, which is generally allowed to elapse between that 
period and the dismissal of the patient, no new arrangement 
is made. No one perceives the cruelty of thus compelling the 
sane to mingle with, and to run all the risks of mingling with, 
the insane. We remove the man recovering from fever from 
the effects of the presence of individuals similarly affected, 
and assist the progress of his convalescence by a change of 
scene or society, cheerful occupations and moderate exercise; 
butno such indulgence, no such precautions against a renewal 
of the disease is extended to the lunatic ; he is left exposed 
to the same influence as before. In France convalescent 
wards exist in almost every asylum, and in our own country 
the propriety of such an arrangement is generally admitted. 
Where any efforts have been made to group lunatics together, 
the principle adopted, that is the classification into noisy, 
tranquil and convalescent, is too vague and too contracted. 



WHAT ASYLUMS ARE. 155 

It is not even enough that the idle shall be separated from 
the industrious, that the depressed and desponding be pro- 
tected from the riotous bacchanal, the tyrannical and the 
deceitful. The slightest differences of disposition, and sym- 
pathies in pursuit or taste must be taken advantage of, and 
made the basis of separation and association. Dr. Abercrombie 
quotes a case from Pinel, exhibiting the evils of ignorance or 
negligence of such indications of treatment. A musician, 
confined at Bicetre, as one of the first symptoms of returning 
reason, made some slight allusion to his favourite instrument. 
It was immediately procured for him : he occupied himself 
with music for several hours every day and his convalescence 
seemed to be advancing rapidly ; but unfortuuately he was 
then allowed to come frequently into contact with a furious 
maniac, by meeting him in the gardens. The musician's 
mind Mas unhinged — his violin was destroyed, and he fell 
back into a state of insanity which was considered as confirm- 
ed and hopeless.* Had his companions been selected from 
musicians, or those who delight in music, or even from the 
calm and amiable, his reason might have been saved. 

There are certain glaring incompatabilities of character 
among lunatics which must strike, and ought to guide, the 
least observant physician in his practice. 

1. Some lunatics enjoy a quarrel; one as a promoter, 
another as a spectator, a third as a participator. 

± The language of one is a mixed jargon of oaths, blas- 
phemies and maledictions : the distempered fancy of another 
receives these as oracles from Heaven. 

3. An oppressor soon discovers a slave ; a sovereign, a 
subject ; a fanatic, some self-deified maniac to worship. 

4. The confiding are betrayed by the falsehoods and chi- 
canery of the cunning: the timid are terrified by brutality 
and arrogance ; the unsuspecting and unprotected are cheat- 
ed and plundered. 

* Inquiries concerning the Intellectual Powers, &.c. p. 353. 



156 WHAT ASYLUMS ARE. 

All recent writers on insanity have spoken loudly in praise 
of moral treatment. But they have spoken vaguely of its 
nature. Each of them attaches a different meaning to the 
word. Employment is the panacea of one ; amusement is 
the specific of another; classification is advocated by a third. 
Now, were every lunatic busily engaged in a suitable occu- 
pation : were recreations adapted to the dispositions or 
previous predilections of all provided : was classification, even 
on the broad basis which I would assign, universally adopted; 
moral treatment, if confined to one or all of these, excellent 
though they be, would be imperfect and comparatively inef- 
ficatious. The authors to whom I have alluded have mistaken 
parts, unexceptionable, it is true, but still merely parts of the 
system for the whole. Every arrangement, beyond these for 
the regulation of the animal functions, from the situation, the 
architecture and furniture of the buildings intended for the 
insane to the direct appeals made to the affections by means 
of kindness, discipline, and social intercourse, ought to be 
embraced by an effective system of moral treatment. Even 
many of the details which affect personal comfort alone are 
of greater importance, as moral, than as physical agents. 
The denial of an article of dress, or an unanswered bell, has 
produced aparoxysm of fury. It is not prudent nor conducive 
to health to comply invariably with the frivolous demands or 
unreasonable desires of lunatics ; neither is it prudent, nor 
will it conduce to health, to act invariably upon the principle 
of resisting these demands and desires, because they are 
frivolous and unreasonable. Both of these errors are detect- 
able in the existing system. The resistance or compliance 
should be regulated not by the nature of the demand but by 
the state of mind of the individual by whom it is urged. 
Great use may be made of self-created wants. The partiality 
for a piece of dress, or a cup of tea, is often found to be a 
more powerful lever in acting upon the intractable, than sage 
counsel or religious impressions. The rule formerly was, 



WHAT ASYLUMS ARE. 157 

and I suspect still is, to render an asylum as unlike the home 
of which the patients had been deprived as possible. In 
application, this was a partial and one-sided rule, however 
specious and judicious it may appear. If the patient's home, 
for instance, had been miserable, no attempt was seriously 
and systematically made to reconcile him to the change by 
increasing his comfort and happiness. The grand object was, 
and perhaps is, to multiply impressions which would inspire 
awe, submission, quiet, a wish to conceal, if not to correct, 
the sallies of inordinate passion ormisdirected intellect, andan 
anxiety to escape from such restraint. This might be calcu- 
lated to subdue the refractory and to weary out the perverse. 
But while, in all probability, it would fail to cure even these, 
what must its effects have been on the much more numerous 
classes, the desponding, the suspicious, the timid, the vain ? 
Placing out of consideration the pernicious influence of such 
a plan in relation to the particular feelings diseased, it obvi- 
ously and unnecessarily diminishes the amount of enjoyment 
in which persons so affected, could, without injury, partici- 
pate. 

In a bill recently submitted to Parliament as to the regula- 
tion of asylums, it was proposed to invest the commissioners, 
to be appointed under it, with the power of visiting all houses 
of the kind during the night.* The proposal was, I believe, 
negatived in consequence of the almost unanimous opposi- 
tion of the medical men consulted on the subject : but it 
indicates two things, — First, a total want of confidence in 
the probity and competency of the managers of such institu- 
tions, and upon this ground it was approved of by some 
medical men ; and, secondly, as total a want of knowledge 
of the interests of the insane on the part of the legislator. 
Such visits might disclose some of the evils which it is desir- 

* Minutes of Evidence taken before the Select Committee, 1S28, 
passim. 



J 58 WHAT ASYLUMS ARE. 

able were corrected, but it would undo all that which quiet 
and care had effected, by rousing every inmate to fear or 
fury, and thus realizing the delusions which sleep so often 
weakens or eradicates. 

There exist a class of injuries connected with that discussed 
above, which are as cruel and destructive of peace as the 
laceration of the lash, or the deep degrading ulcer excavated 
by the fetter, but which no medical or other commission, 
however probing and penetrating its inquiries, could reach. 
The inquisitors might be actuated by the best motives and 
by the clearest views of the great duty which they had under- 
taken, and their visits might have been often repeated, 
.unannounced and inopportune, and yet nothing but the 
most glaring errors and inconsistencies of the system which 
they desired to investigate could be detected. They could 
see the physical misery which it inflicted, the disease and 
death which ensued, and they might believe that the sum of 
its iniquities were numbered. But they could not see the 
thousand moral impressions of pain and anxiety and offended 
delicacy which daily and hourly embittered the existence of 
the lunatic. They could not separate the suffering which 
was the result of insanity, from that which arose out of the 
situation in which the lunatic was placed, or from the various 
sources of annoyance to which he was exposed. The inter- 
ested and offending party would be the last to reveal the 
insults, the ridicule, the disgusting expressions, or, where 
no intentional culpability could be charged, the offensive or 
irritating conversation with which he assailed his victim : 
and, unfortunately, the testimony of that victim is not re- 
cognized as admissable. I hold this disqualification to be 
not merely unfortunate but unjust. A wide distinction 
ought to be drawn between the evidence of an insane per- 
son as to what he believes and as to what he feels. His 
opinions may be delusions, his feelings cannot. Under a 
system, the grand principle of which was fear, he might, if 



WHAT ASYLUMS ARE. 159 

unconscientious and desirous to deceive, complain of greater 
injuries than what he actually received: but still there would 
exist ground for his appeal. Under a rule of love, there is 
nothing real or imaginary of which to complain. From this 
distinction never having been acknowledged, and from con- 
stantly rejecting every statement made by a lunatic as 
unworthy of credit, the information on this part of the 
subject is necessarily defective. Enough, however, has 
been ascertained, and enough even now remains of that 
disregard to the feelings of insane patients, that some idea 
may be formed of the nature, although not of the extent of 
the moral torture to which the}' were necessarily subjected. 
It is to be hoped that this callous indifference proceeded, 
and is still manifested, in many cases at least, from the pre- 
posterous assumption that lunatics had no feelings, that they 
did not feel as other men. Their bodies were said to be 
unaffected by cold, and it was concluded to be analagous 
reasoning to hold that their minds could not be stung by 
shame, or dishonour, or injustice. But our business is less 
with the cause in which such conduct originated, than with 
its disgraceful inhumanity and its evil consequences. The 
exploded system has been well characterized as one in which 
"madmen were employed to torment madmen," and the 
following relations, applying although they do to the re- 
mains only of that system, appear to justify the force of the 
accusation. Keepers, the tormentors alluded to, rarely at- 
tempt to soothe or persuade : in addressing their charges 
they employ at best heartless or harsh terms, and often 
oaths and blasphemies, upon the principle of terrifying into 
obedience. I do not doubt the success of such an expedi- 
ent. But if it be recollected what effect such expressions 
will produce on a well-constituted mind : upon the timid, 
or the virtuous : if it be recollected, that in the irritable and 
the passionate they will excite propensities corresponding to 
those from which they emanate, it may be imagined, that 



160 WHAT ASYLUMS ARE. 

they fall with tenfold force upon minds impaired and ener- 
vated by disease, labouring under the monomania of fear, 
viciously disposed, and, at the same time, furiously mad : 
upon all, in fact, and there are ninety such in every hun- 
dred, retaining a sufficient degree of intelligence to under- 
stand the import, and a sufficient degree of feeling to be 
disturbed and disgusted by the ribaldry and cruelty of what 
is addressed to them. The mind in many cases of mania, 
in place of becoming obtund or deadened, is endowed with 
an unnatural sensitiveness, with an acuteness of perception, 
upon which the insults and insinuations of the rude or the 
indelicate, or the positively cruel must act in the same raan- 
•ner, and must produce pain upon the same principle that 
harsh sounds and bright light grate upon the eye and ear 
when excited by fever. 

To females, whom nature has wisely made more keenly 
alive to propriety of external deportment, and to the refine- 
ment and purity of language, it has been proved, that the 
most gross obscenities have been addressed, the most offen- 
sive gesticulations exhibited, and this by individuals of their 
own sex, by those very persons to whose tender mercies 
they were intrusted. The maniacs may or may not have 
been sensible of the treatment which they received, its bru- 
tality will not, however, be abated one jot by supposing that 
it was expended in vain. Females who, from their original 
situation in life, had been accustomed to all the luxuries of 
dress, have been allowed to expose themselves in a state 
bordering upon nudity, and then derided for the exposure. 
If the unfortunate sufferers were at any time conscious of 
their condition, how bitter the taunt : if reason ever return- 
ed, how bitter the recollection. The observation has often 
been made by those who have paid but transient visits to 
institutions for the insane, and is perfectly familiar to those 
who have been domesticated in such abodes, that the impre- 
cations, profane and indecent expressions, which are heard 



WHAT ASYLUMS ARE. 161 

even from the lips of those who, previous to the incursion of 
the disease, it is certain were respectable, chaste and virtu- 
ous, are horrible and altogether unaccountable. On making 
this remark to a physician who has spent a long lifetime in 
philanthropical attempts to uproot the prejudices and in- 
justice which obtain wherever the insane are concerned ; and 
adding my surprize as to where patients of superior rank 
and unblemished reputation could have learned such words, 
the rejoinder was emphatic and humiliating, — " Sir, they 
have been taught here : the wages of our servants are ex- 
tremely low : we are accordingly compelled to receive what- 
ever applicants may present themselves without much scru- 
tiny as to character or previous conduct, and consequently 
the vile and abandoned flock to us because they will not be 
admitted elsewhere, and because we must have keepers. 
They inevitably bring with them their vices, and although 
under a certain degree of moral restraint, they cannot be 
prevented from propagating them, and thus corrupt all 
around, debasing still further those whom it is their duty to 
elevate." This happened in a country which boasts, and 
perhaps truly, of having taken the lead in the race of im- 
provement, where paupers live in palaces, and a certain 
class of pensioners are served off plate. The blindness of 
Humanity is often singularly contrasted with that of Justice. 
The assertion, quoted above, must not be admitted without 
certain limitations, in as much as there are certain forms of 
mania which predispose, independently altogether of the in- 
fluence of servants or any other secondary cause, to the use 
of the most gross and revolting language. 

The practice of ill-disciplined school-boys has often been 
transferred to those places of refuge, where the imbecile or 
lunatic seeks, or at least ought to find protection from ag- 
gression ; and the very helplessness or delusion which it is the 
object of such places to remove, has been made the subject of 
merriment or derision. Conceive the poor idiot serving as 



162 



WHAT ASYLUMS ARE. 



the butt for his protector or physician. Certain animals 
destroy or persecute the weak and defenceless of their own 
species ; man, without the guidance of the higher sentiments, 
acts similarly. Sane and insane acts from the same im- 
pulses, and in the latter, as well as in the former, there exist 
sore points, jarring strings, which, if touched, the whole soul 
is roused under the infliction of pain to incontrollable fury, 
or to that degree of excitement when its peculiarities be- 
come visible. This experiment was frequently tried, and 
for a very obvious reason, especially when visitors were pre- 
sent. The very flame which it was essential to smother, 
was thus fanned and kept perpetually burning. The proud 
maniac was told that he was not a king, in order to witness 
the extent of his royal rage : the desponding maniac was 
confirmed in his forebodings and fears, that the wildness of 
despair might be embodied; and the incoherence of the 
idiot was encouraged, that a laugh or a jest might not be 
wanting. A still more systematic mode of aggravating 
disease is on record, where two lunatics were induced to 
quarrel — were inspired with mutual dislike and distrust — 
where the strong was allowed to tyrannize over the weak, 
or the fool set to mock the fool. It is somewhat difficult to 
estimate either the motives or the effects of such conduct. 
But this much may be affirmed, that as neither cure nor 
alleviation could possibly be the object, neither could they 
possibly be the result. Pinel acknowledges, that in his own 
experience, lunatics, who were perfectly composed, and in 
a fair way of recovery, have, in consequence of the silly 
raillery and rude brutality of their attendants, relapsed into 
the opposite condition of violent agitation and fury.* Tuke 
gives an instance of the same kind.f These statements 
may, and I hope will be received with loathing ; but it is 
necessary for the accomplishment of the object now in view, 

* Pinel. Treatise on Insanity, p. 67. 
•Y Description of Retreat, &c. p. 144. 



WHAT ASYLUMS ARE. 163 

that the whole truth should be known. There is a diffi- 
culty in determining the amount of misery the human heart 
can bear : there is equally a difficulty in determining the 
amount it will inflict. The following description, however, 
which is quoted verbatim, lest a particle of the effect should 
be diminished or increased by a change of expression, ap- 
proaches as nearly to the climax of human suffering and 
human ferocity as can be imagined. " Another case which 

I laid before the governors, was that of the Rev. Mr. 

He was a clergyman reduced to indigence, I believe, in 
consequence of his mental complaint. He had at times, and 
for considerable periods, intervals of reason. In these in- 
tervals, when he was perfectly capable of understanding 
every thing that was said or done to him, repeatedly in the 
presence of his wife, he was exposed to personal indignity ; 
and on one occasion, he was inhumanly kicked down stairs 
by the keepers, and told, in the presence of his wife, that 
he was looked upon as no better than a dog. His person 
swarmed with vermin ; and to complete this poor man's 
misery, the keepers insulted his wife with indecent ribaldry, 
in order to deter her from visiting him in his unfortunate 
situation. He had a gold watch which was lost there, and 
which his wife could never recover."* This description be- 
longs to the past ; but unfortunately, all the features of which 
it is composed, with the exception, perhaps, of personal vio- 
lence, might be used to characterize the evils of the system 
still prevailing. Within a very short period, an instance has 
fallen under my own observation, of a superintendent re- 
fusing to sit down at table with a lady, one of his own 
patients, and a person of good birth, education and man- 
ners, because, and the reason was used in her presence, she 
was a « mad creature." Surely it is a matter for regret, 
that to men so ignorant and brutal, should be committed 

* First Report from Committee on Madhouses, 1815. Evidence of 
Godfrey Higgins, Esq. 



164 WHAT ASYLUMS ARE. 

the care of the " mind diseased." For weeks, and some- 
times for months, they have the sole and irresponsible 
control of hundreds of patients ; they constitute at once the 
legislative and the executive ; they decree, and with their 
own hands inflict punishment ; or, should they feel disposed 
to diminish their labours, they subsidize convalescent pa- 
tients to perform the more menial duties, reserving for 
themselves all the higher privileges of office.* The indis- 
criminate employment of lunatics who are partially recovered, 
to wait upon their less rational companions, is certainly to 
be condemned. Under proper regulation, the attachment 
of one patient to another, either as a friend or a servant, 
proves highly beneficial to both parties ; but what is least 
justifiable in the custom to which I have adverted, is the 
substitution of patients for keepers, endowed with all the 
tremendous power of coercing, confining, punishing, and 
further, the detention of these useful convalescents, in order 
to diminish the number of regular attendants. 

The necessity for employing only well educated servants 
in the care of the insane, has been so strongly felt in France, 
that in many establishments the keepers are required to have 
undergone a system of training previous to their appoint- 
ment. They serve a sort of apprenticeship, if the expression 
be allowable, attending some of the large public asylums as 
assistants, where they have ample opportunities for observa- 
tion, but are not intrusted with the charge of patients. This 
laudable example has, in some few cases, been followed in 
our own country. Tuke states, " several persons about to 
engage in the superintendence of similar establishments, 
have made a temporary residence at York, and have been 
permitted to observe daily the economy of the house, and 
the mode of managing the patients."f This is the true way 
of grappling with the evils of the old system. We require 

* Report Pauper Lunatics in Middlesex, pp. 171, 33, &c. 1827. 

t Description of Retreat. Preface, p. 12. 



WHAT ASYLUMS ARE. 165 

certificates of character from cooks and coachmen ; we ex- 
pect from them previous experience, probity, a knowledge 
of the duties they have to perform. It is never dreamed, 
that the rude hewer of wood, and drawer of water, can at 
once be transformed into the compounder of the delicacies 
of the table, or the guardian and guide of animals " of price." 
A greater transformation, however, has hitherto been ex- 
pected to take place, in those promoted from wielding the 
shuttle, or erecting a dwelling-house, to wield the happiness 
of men, and in great measure reconstruct the shattered mind. 
It has never been considered that the keeper is the principal 
agent in leading the mind back to its original condition. 
Many difficulties exist in this country, which must be over- 
come before such training as that instituted in some parts 
of France could ever be proposed. Our asylums are shut 
against the medical student who pants and would pay ex- 
orbitantly for the instruction to be gathered within ; and 
it would be vain to hope that in this age of speculation 
they will be opened to the domestic, whose only plea for 
admission is poverty. But although it be highly desirable 
that those undertaking so delicate and difficult a task should 
be suitably prepared, sound objections may be urged against 
the conversion of asylums into normal schools for this pur- 
pose. Unless such a suggestion could be carried into effect 
in some of the large metropolitan institutions appropriated 
exclusively to paupers, its success must be despaired of. 
The reservation " exclusively to paupers" is used advisedly. 
Wherever the rich lunatic is confined, a veto will at present 
be placed upon such a plan. But on the same principle, 
and I regard it as dictated by the most exalted humanity, 
that the poor, labouring under disease of the body, when 
admitted to an hospital, partly remunerate that public by 
whose charity they are supported and treated, by contribut- 
ing to the instruction of the surgeon and physician, in like 
manner might nervous disease be studied, and the treatment. 



■166 WHAT ASYLUMS ARE. 

moral and medical, of such of its victims as are placed in 
public asylums, be observed by those who are ultimately to 
be engaged in attempting to mitigate similar cases. In place 
of the patients being injured by the admission of students, 
they would in many cases be decidedly benefited: and 
wherever the consequences of such a visitation would be 
either dangerous or doubtful, no judicious physician would 
allow it to take place. At Salpetriere this system of tuition 
has been long in operation. Until this view be taken, or 
until it be practicable, there is still another expedient by 
which respectable and well-informed men might be se- 
cured as attendants. As these must be selected from the 
mass of the community, their qualifications will, of course, 
he more general and characteristic of the class to which 
they belong. We must be content with kindness of heart 
and intelligence. To these there need be no limit. But 
how, it may be inquired, can individuals so endowed, be 
drawn from their ordinary occupations ? The answer is, 
by raising the status in society assigned to them, and by 
very largely increasing the remuneration they receive. 
The cooks and coachmen, whose case has been before 
quoted, are paid by enormous, but it may be adequate, 
salaries ; larger, or, at least, in many instances as large 
as those given in situations requiring the exercise of talent 
and a long preliminary education. To those, again, whose 
care is the human mind, — for in no other light can the 
office of an attendant upon the insane be viewed, — a pit- 
tance is given, not only far below the allowance to cooks 
and coachmen, but which is even less than can be realized 
by the common artizan, by thousands engaged in the most 
servile employments. And if it be recollected, that the 
labour of the conscientious keeper never terminates, that he 
has neither nights nor days of rest, that anxieties, provoca- 
tions, disappointments, and disgusts, follow each other in 
constant succession, that his only respite is, or ought to be, 



WHAT ASYLUMS ARE. 167 

in the recoveiy of his patients, it will become matter for sur- 
prize that any one, however humble may be his pretensions, 
can be induced to submit to such bondage. There do exist 
exceptions to the rate of payment now condemned, but they 
are few and far between. 

From the peculiar situation of a keeper, he is invested with 
great and but ill defined power, and, as is ever the case, is 
prone to abuse it. If his disposition be kind, he is inclined 
to favouritism : he grants unwarrantable indulgences ; he 
deviates from the rules of the dietary, should there be one, 
in order to gratify some capricious appetite : he commiserates 
where he ought to repel, and soothes where he ought to 
command. If, as is more frequently the ease, his temper be 
irritable, malicious, or his conduct regulated by the current 
opinions respecting madness, he will prove a despot, anxious 
to exercise his functions, brooking no opposition or remon- 
strance, encouraging no confidence or affection : he will 
annoy by petty grievances, excite by oppression or absolute 
cruelty : he will employ restraint, prohibit ail intercourse 
among the patients, or between these and their friends ; he 
will intercept and destroy all letters, petitions, &c., and be as 
unscrupulous in his conversation as in his conduct. TheM 
an; vices springing out of false views or bad management, 
which are still uncorrected. It is evident that they could 
not exist were the servants of a more elevated and a better 
educated class, or were the superintendents, by whom they 
are directed and instructed, and under the sanction of whose 
authority they at all times nominally act, either less assimi- 
lated to them in character and condition, or more rigidly 
conscientious in the performance of their own duties. 

Complaints are often made against the cruel separation of 
relations consequent on the isolation of lunatics, and especi- 
ally of the obstacles thrown in the way of subsequent com- 
munication to which I have referred. The necessity for 



168 WHAT ASYLUMS ARE. 

excluding friends has unquestionably been exaggerated ; and 
the rule founded upon it, by being made applicable to all 
cases, has become injurious and oppressive. The presence 
of relatives, and the emotions they excite, are occasionally 
highly salutary. But although the accusation against super- 
intendents and servants of asylums of estranging those who 
might safely be allowed to meet, be perfectly just, a much 
graver and more startling accusation may be urged against 
the vast majority of the friends of the insane themselves. It 
is that of utterly forgetting or abandoning those to whom they 
are bound by ties of kindred and long companionship, if not 
of affection, and who might be improved, and who could not 
possibly be injured by their presence and counsel.* The 
difficulty of inducing friends to visit the insane is generally 
felt by superintendents to be much greater than that of pre- 
ventingorregulating their visits. I have known the mother of a 
family, the members of which were moving in a respectable 
grade of society, remain in an asylum for thirty years, who was 
neither visited nor sought to be visited, save once, by husband, 
children, or friend. Children are consigned to this moral obli- 
vion by their parents; parents by their children. Remonstran- 
ces from medical advisers are often of no avail : the stroke of 
disease seems to have enfeebled affection in the one, because it 
has obliterated reason in the other : and the death- bed is the 
only point at which reunion takes place, if even then. I have 
seen many individuals in the French asylums, Whose name, 
origin, and country, are now altogether unknown, or conjec- 
tural. This has arisen partly from the imperfect manner in 
which the entries were formerly made in the books, but 
chiefly from these deserted beings having outlived the me- 
mories or the kindness of their friends. This humiliating 
description is particularly applicable to the condition of lu- 
natics supported by public charity. The rich cannot forget 

* Report. Pauper Lunatics in Middlesex, 1827, p. 155. 



WHAT ASYLUMS ARE. 169 

their insane connexions, even when most disposed to do so, 
as they must dole out a yearly pittance for their support. 

The very affluent, however, do not place their relations 
in asylums simply because there are no suitable provisions 
for their reception. And they act wisely. To strip a man 
suddenly, and for no reason that he can comprehend, of all 
the luxuries and elegancies to which he has been accus- 
tomed, and expose him to the bald simplicity or meagreness 
observed in establishments for the insane, would overthrow 
a tottering mind, and totally crush one that has been already 
weakened. Upon all men the transfer from a palace to a cell 
in Bedlam, would be a dangerous experiment, and upon such 
as are bowed down with misery, or rabid with passion, the 
effect cannot be salutary. More enlightened views are now 
adopted, and fitting preparations are made which will tempt 
the rich to have recourse to those measures from choice, 
which the poor have long pursued from necessity. In ar- 
ranging and adorning suites of apartments, however, in lay- 
ing out gardens and pleasure grounds, in providing sources 
of amusement, instruction and occupation, aud in increasing 
the liberty, convenience and comfort of the patient of rank, 
it ought to be kept in view that no mere appetite is to be pam- 
pered, no idle whim humoured, that the only object in view 
is to avoid giving pain, where pain could be of no service. 
Occasionally a hermit's dinner and a dark room may be ne- 
cessary to convince a lord that he is human, or to convince 
a commoner that he is no lord : but these deprivations are 
then employed upon the same principle as the shower-bath, 
not from any foolish notion that either the want of comfort, 
or the cold water will actually convince the distempered rea- 
son, but that they will act medicinally, quiet the excitemen 
upon which the delusion depends, and permit the functions 
of the nervous system to remain undisturbed by the process 
of digestion, or impressions from the external senses. No 
possible evil can accrue from a patient being clothed in the 

i 



170 WHAT ASYLUMS ARE. 

same dress, surrounded by similar articles of furniture, or 
in the enjoj^ment of the same pursuits, as when mingling 
with the world., provided these are neither inimical to health, 
nor inconsistent with virtue. Disadvantages do flow, how- 
ever, from granting indulgences, to which the patient is 
neither entitled nor accustomed. This occurs chiefly with 
regard to diet. The irritable temper is soothed, the way- 
ward disposition is coaxed, and the sickly or capricious 
appetite is tempted by a profusion of delicacies which, while 
they effect the object immediately in view, and restore order, 
and subordination, and cheerfulness, poison the source of 
future peace and ultimate recovery, by encouraging a re- 
newal of irritability and waywardness, and by vitiating the 
jfrocesses of digestion and nutrition. This practice of ena- 
bling patients to live well, as it is termed, can often boast 
of no better origin than a desire to bestow kindness, to 
afford a gratification of which all men are supposed to be 
fond, and which is as generally supposed to be innocent. 
This lamentable ignorance of the laws of the economy, has 
given origin to another practice more generally adopted, and 
even more pernicious. All the inmates of an asylum, al- 
though they may amount to many hundreds, will be found 
to have the same diet prescribed for them ; and not only 
will their allowance consist of the same description of food, 
but of the same quantity. The old, the young, the robust, 
and the debilitated — those who are free from, and those who 
are affected with bodily disease — the furious and the fatuous 
—the confirmed and the convalescent lunatic, are one and 
all condemned to the same regimen, which may be adminis- 
tered by a lavish hand, and dictated by a compassionating 
heart, but which must be incompatible with the condition 
of one half of those who receive it, precisely because it is 
adapted to the condition of the other half. It would be as 
reasonable to expect that five hundred men, all of them less 
or more diseased should approach the same meal with the 



WHAT ASYLUMS ARE. 171 

same degree of appetite, as that they should all be endowed 
with the same powers of digestion. I am perfectly aware 
that certain difficulties exist in carrying a dietary, founded 
upon sound physiological principles, and upon a considera- 
tion of every individual case, into execution. But no diffi- 
culties of whatever amount, should prevent the attempt 
being made ; and I am fully convinced, that under proper 
management it will be completely successful. In many 
asylums it is the custom to serve up the meals to the patients 
belonging to the higher grades, in their own apartments, and 
in solitude. This is to be condemned. The repast, pre- 
sented in such a manner, is cheerless ; it brings with it none 
of the ideas of comfort and contentment which should in- 
variably be superadded to the gratification of appetite. It 
is eaten with a rapidity and voracity which put the powers 
of deglutition and digestion to a severe test. It is so pre- 
pared as to do away with the necessity of sending in knives 
and forks. Every circumstance bears the impress of degra- 
dation and suspicion. The patient has no inducement to 
retain the observances of civilized life. There exists no 
check to the substitution of negligent or filthy habits. All 
which results, as they depend on the dominion of the in- 
stinctive, or the extinction of the intellectual powers, are 
obstacles to improvement. Convenience and economy will 
most fortunately prove allies to humanity, in bringing about 
a change in this respect. It is easier for the domestics, and 
cheaper for the establishment, that the patients, when not 
prevented by the nature of their malady, should eat in 
society, and if practicable, at the same table with the super- 
intendent or matron ; or when paupers or poor, under the 
eye of a keeper. The presence of those whom they re- 
spect, or of strangers whose applause they desire, will act as 
a restraining force ; ebullitions of passion or folly will be 
controlled ; the usages of society adhered to, and the resto- 
ration of sanity promoted. 



172 WHAT ASYLUMS ARE. 

Passing from these objections, it will long be difficult to 
convince the rich, who can purchase other, and, as they 
imagine, better modes of isolation, that the vicious condition 
brought home to certain asylums no longer continues, or to 
allay the horror inspired by the prospect of being exposed 
to the system supposed to be prevalent in all, because cer- 
tainly prevailing in many. How deeply this opinion is 
rooted, is shewn by an application made a few years ago, to 
Dr. Fox of Brislington. A gentleman who was about to 
place his brother under Dr. Fox's care, said, " I hope you 
will be as gentle to my brother as you possibly can." 
" Certainly," said the Doctor. " I know/' resumed the 
^applicant, ' f It is very necessary you should exercise some 
severity on him ; but I hope it will be as gentle as possible." 
Dr. Fox asked him what he meant. " Sir," said the gentle- 
man, " I understand it is necessary that you should let him 
go through a considerable degree of flagellation." " Sir," 
was Fox's indignant rejoinder, ** You have brought him to 
the wrong place. I would never carry on a concern of the 
sort were I obliged to resort to such measures."* While 
the greatest proportion of the evils and errors chargeable 
against asylums as they are, can be proved to be inseparable 
from the plan upon which they are conducted ; many of the 
most praise-worthy attempts to enlarge the sphere of the 
lunatic's joys, and to increase the chances of his recovery, 
are frustrated or impeded by the prejudices and timidity of 
the public. We are told that in America a man's Chris- 
tian privileges are abridged on account of the colour of his 
skin, and that the proscribed African cannot be permitted to 
worship in the same pew with the favoured pale-face, that 
God who is no respecter of persons. An objection which 
must have sprung from the same root, excluded the conval- 



* Minutes of Evidence taken before the Select Committee, &e 
1828. p. 22. 



WHAT ASYLUMS ARE. 173 

escents belonging to the Harwell Middlesex Asylum, from 
the parish church. The knowledge of the fact, that certain 
of their fellow- worshippers had at one time suffered under a 
grievous malady, for a deliverance from which they had 
come to testify their gratitude, disturbed the tranquillity 
and devotion of these exclusive pietists. They would not 
kneel down with those who had been stricken in spirit ; 
they would not mingle their voices in the thanksgivings of 
those whose hearts overflowed with love and adoration ; 
they could not commune with their God in such society. 
And yet may we not, are we not bound to hope that these 
Pariahs in religion shall crowd the ranks, and swell the 
hallelujahs around the throne of mercy? Here was the 
promulgation of a ban against moral leprosy. The fiat was 
respected, and the offending outcasts withdrawn. But the 
persecution did not rest here ; and although the next blow 
was comparatively innocuous, it serves to show how steadily 
and surely the spirit of improvement is met by the spirit of 
resistance. A pony chaise had been procured by the su- 
perintendent of the same asylum, in order to present a 
temptation to many of the patients to prolong their excur- 
sions to a distance, and to enable the weak or indolent to 
diversify their walks within the grounds, by drives through 
the neighbourhood.* But the inhabitants protested against 
such an invasion of their rights, such a destruction of their 
comfort. They could not, forsooth, so delicate was their 
sensibility, bear the sight of mad people. The remonstrance- 
was again attended to, and the lunatic is again deprived of 
his transient glimpses of happiness, of his visits to what is 
literally to him another world. 

There is little hope that any legislative interference could 
finally arrest these abuses or eradicate these prejudices. It 



* The Hamvell Lunatic Asylum, by Miss H. Martineau. Tait' 
Edinburgh M<i£az ; ne. June 1834. p. 309- 



174 WHAT ASYLUMS ARE. 

could do much ; but the removal of ignorance is somewhat 
beyond its power. So far, however, as an act of government 
can be instrumental in offering a premium for knowledge, and 
in discouraging quackery and speculation, some benefit might 
result. Were men of enlightened minds, liberal education, 
and kind dispositions, alone appointed or permitted to attend 
the insane : in other words, were those who pretend to cure 
required to understand the human mind, these abuses would 
disappear. To accomplish this, it would become necessary 
that all asylums should be public and under the control of 
government, or of parties incorporated by charter for the 
purpose. The great objects in such a change would be that 
all the proceedings of those immediately intrusted with the 
insane should be patent to the public and to the legal authori- 
ties, and under the management of a body whose sympathies 
are all engaged in favour of the patient rather than of his 
attendants. To bring about such a revolution as would place 
all asylums in the class of public hospitals, there would be 
required no act of suppression, no bill of pains and penalties 
against private asylums, houses of detention, &c. Render 
county asylums perfect, elevate all to the rank which afewnow 
occupy, give them the means and the reputation of curing 
ninety in place of forty-two in a hundred, and increase their 
opportunities of affording protection and happiness to those 
who cannot be further benefited, and the number of private 
institutions would speedily decrease, and if improvement was 
pushed sufficiently far, they would, in all probability, cease 
to exist : or, should this result not ensue, they must, in self- 
defence, adopt the system pursued by their rivals, a step 
which would effect all that is desired or desirable. The 
difference between the interests of the proprietor of a private, 
and the superintendent of a public establishment is very 
obvious. It is the interest of the former to detain as long, 
while it is the interest of the latter to dismiss patients as soon, 
as possible. The man who is the servant of, and is paid by, 



WHAT ASYLUMS ARE. 175 

the public, is anxious for, and knows that his prosperity 
depends upon, cures ; whereas, the man who is paid by the 
patients or their friends, knows, or thinks that his prosperity 
depends upon admissions and the duration of the complaint. 
This may be a short-sighted but it is a common policy. I 
do not mean to insinuate that such motives generally actuate 
the proprietors of such establishments. Many of these are 
models of the system which is here advocated. But such 
principles of action may be, as it is known that they have 
been, the cause of protracting the cure of the convalescent 
and of perpetuating the imprisonment of the sane. The merit 
of the change now proposed would consist in preventing any 
act to which a humane and intelligent body of the community 
were not parties, and of divesting the care of the insane of 
every occasion for the exercise of selfish and unworthy 
motives. 



176 



LECTURE V. 



WHAT ASYLUMS OUGHT TO BE. 

A perfect asylum a Utopia — Belief of the inadequate provisions for the 
cure of the insane in asylums, general — Character of the physician 
— Benevolence, conscientiousness, courage — Intellectual qualifica- 
tions — Site of an asylum — It may contribute to the cure of the 
inmates— Construction of the building — Size of apartments — Night- 
classification — Houses of one story — Dormitories — Night-keepers — 
• Portion of asylum fireproof— Padding of walls— Heating the apart- 
ments by the circulation of hot water — Clothing — Airing-grounds — 
Shrubberies — Gardens — Farm-employment of patients — Payment for 
labour — Classification — Religious worship and instruction — Fallacies 
in moral treatment — Dancing — Voisin's and Esquirol's establish- 
ments — Asylum at Sonnenstein — Library — Asylums at Naples, at 
Hartford, United States — Visit to an asylum as it ought to be. 

A perfect asylum may appear to be a Utopia ; " a sight to 
dream of, not to see." It would be miserable policy to gratify 
the ambition of the heart so far, or to pall the keen appetite 
for doing good by admitting that any attempt had succeeded 
in placing such retreats in complete accordance with the 
necessities of the diseased mind. It would, in fact, be to 
return to the old rule of " letting well alone." Unfortunately, 
and, what is more to the purpose, it would be untrue. But 
near approaches have been made to what reason and human- 
ity point out as the standard of excellence. From these, and 
from that standard itself, materials may be obtained for the 
construction of a model which may serve to show how far 
distant we still are from what must be the object of every 
enlightened mind, and by what means that object is to be 
arrived at. 



WHAT ASYLUMS OUGHT TO BE. 177 

The whole secret of the new system and of that moral 
treatment by which the number of cures has been doubled 
may be summed up in two words, kindness and occupation. To 
carry this system into effect, the first requisite is a mind which 
understands the wide meaning of these words. I have shewn 
that the grand objection to the present mode of conducting 
madhouses is rather that there is no system than that there 
is a bad one. The gross indecorums and neglect and inhu- 
manity are abandoned, and the regulations which rendered 
mismanagement obligatory are cancelled, but there have been 
substituted no measures which shall render the recurrence 
of such errors impossible; at the same time securing the 
observance of those attempts at alleviation, of which every 
case of lunacy admits, and the application of those principles 
upon which the cure of so many depends. The opinion was, 
and perhaps still is, prevalent, that if a building of suitable 
dimensions and security was provided, and if medical advis- 
ers occasionally saw the inmates, all was done for the insane 
that could be expected or that could be useful. Every day, 
however, shews that these provisions are utterly inadequate 
to the end proposed, if that end be the recovery and not the 
confinement of the insane ; that they form the first but the 
smallest and most insignificant link of a mighty chain of 
merciful measures, which must lengthen with our increased 
acquaintance with the laws of the human mind and the pri- 
vations of that mind, and can only terminate when the insane 
are out of the land. So indifferent is even now the repute 
of public asylums, that the physician in many instances re- 
commends change of scene or of occupation, travelling, 
anything in fact rather than mere incarceration. And he 
gives this advice not from any preference of the step suggest- 
ed, but from a conviction that mere isolation can do no- 
thing, and that isolation, combined with treatment founded 
upon mistaken views of our moral nature, can do little to 
promote his object. Even when to isolation is added the 



178 WHAT ASYLUMS OUGHT TO BE. 

best treatment which the science of medicine indicates, 
very little additional confidence is inspired, as however 
useful the established routine of bleedings, blisters and 
baths may prove to be as auxiliaries, the experience of a 
thousand years has exposed their worthlessness when trusted 
to alone. A want of power or inclination to discriminate 
between the inutility of medicine from its being inapplicable, 
and from its being injudiciously applied, has led to the adop- 
tion of the absurd opinion that the insane ought not to be 
committed to the charge of medical men. A manager of a 
large and excellent institution, entertaining this view, has 
declared that the exhibition of medicine in insanity was 
useless, and that the disease was to be cured by moral treat- 
ment only. To the mere drug exhibiter, to the man who 
conceives that he can combat mania by the lancet and tartar 
emetic alone, or who believes that he can exorcise melan- 
cholia by a purge, it would certainly be unpardonable folly 
to commit the insane ; although an authority of equal weight 
to that quoted above has expressed the opinion, " that apo- 
thecaries must know much more about the practice of 
medicine than physicians, because they are so much more 
among drugs."* But to whom, rather than the well-educated 
physician, is such a sacred and momentous trust to be con- 
signed. The word well-educated is employed advisedly and 
in its most comprehensive sense. The combination of quali- 
fications which it represents is assuredly rare, but it is as 
assuredly indispensable. The basis of such a character must 
be dispositions truly Christian and catholic. Coleridge hassaid 
with great acumen, that, "in the treatment of nervous disease, 
he is the best physician who is the most ingenious inspirer 
ofhope."f There must exist a benevolent kindness which 
shall be so deep and expansive as to feel sympathy for the 

* Crowther, Observations respecting the Management of the Pau- 
per Lunatic Asylum at Wakefield, p. 13. ]830- 
■t Table- Talk, p. 99. 



WHAT ASYLUMS OUGHT TO BE. 179 

lunatic, not merely because he is an alien to his kind, be- 
cause he is visited with the heaviest and hardest affliction 
which humanity can bear and live ; but will feel an interest 
in those unreal and artificial and self-created miseries with 
which the distracted spirit is oppressed, and which will be 
as solicitous to alleviate suffering, where it is absurd and 
the result of violence and perversity of temper, as where it 
flows from misfortune. There must be a benevolence which 
will be prepared to make the lunatic a companion and a 
friend in all the essential qualities of reciprocal confidence, 
mutual forbearance, fellow-feeling, and rational counsel, 
which will in all cases forget that an awful but not an 
unpassable gulf of obliterated acquirements, numbed or le- 
thargic emotions, and darkened reason can separate two 
beings born of one family ; and only hold before the mind's 
eye the things that still remain in common. There must be 
that benevolence, which will, at an immeasurable distance, 
imitate the mercy of Him, who, in curing the broken and be- 
wildered spirit of demonomania, " took him by the hand and 
lifted him up." But this gentleness must be controlled ; it 
must be graduated. It may sink into a barren sympathy, 
or, more fatally for the welfare of those towards whom it is 
directed, it may be active in soothing momentary pangs at 
the sacrifice of permanent peace; it may indulge vicious 
propensities, it may give way to unreasonable demands, it 
may rather than inflict uneasiness foster those very delusions 
and irritability which are the root of the disease. The 
purely benevolent physician can never be a good practi- 
tioner. There must be mingled with such a sentiment that 
highly refined sense of duty, that keen perception of right 
which guides even kindness and affection in their ministra- 
tions, and which holds the balance as scrupulously in de- 
ciding on the moral rights of lunatics as on the civil rights 
of our fellow-citizens. That this quality is required, in 
order to secure the discharge of the ordinary obligations of 



180 WHAT ASYLUMS OUGHT TO BE. 

regular attendance and the exertion of every means pre- 
scribed for the alleviation of insanity, every one must see 
and admit. But it appears to be even more essential and 
more important in indicating what the conduct of the phy- 
sician and his subordinates ought to be towards their charges, 
in enabling the former to feel what are the real interests of 
the latter, and, aided by judgment, in distinguishing the 
degree of responsibility attachable to each action ; but above 
all, in conferring that impress of high integrity and honour 
which is appreciated and reverenced and confided in almost as 
generally among the insane as among the most shrewd and 
intelligent of mankind. In this light, a disingenuous and 
unconscientious, in other terms, a bad man, cannot be a good 
physician. But even these noble attributes would be of 
little avail in the trying situations in which the curator of 
the insane is placed, without that moral and physical courage 
and firmness which confer calmness and decision in the 
midst of danger, and in dealing with the most furious and 
unlistening madness, and imbues the whole character with 
that controlling influence, which, tempered with mercy and 
justice, governs the turbulent while it appears to guide, and 
commands the most wild and ferocious by the sternness and 
at the same time by the serenity of its orders, — by the absence 
alike of timidity and anger. The intellectual qualifications 
for such a trust are high and varied, but cannot easily be 
specified. They must comprehend a familiarity with the 
true and practical philosophy of the human mind, in order 
that its diseases may be understood and controlled ; as ge- 
neral an acquaintance as is practicable with the usages and 
workings of society, with the habits, the pursuits, and the 
opinions and prejudices of different classes, with literature 
and science so far as they contribute to the instruction, 
happiness, or amusement of these classes, with every thing, 
in short, which is or can be rendered influential in what 
may be called adult education, in the management or modi- 



WHAT ASYLUMS OUGHT TO BE. 181 

fication of character, in order that as great a number of 
moral means of cure, of restraining, persuading, engaging, 
teaching the darkened and disordered mind may be created 
as possible ; and finally, as liberal a professional education 
as long preliminary study and equally long practical observ- 
ation can accomplish, in order that the causes of alienation, 
the physiological conditions by which its duration and 
intensity may be increased or diminished, and the operation 
of medicines or external agents in removing or modifying 
either the one or the other, may be thoroughly mastered. 
To acquire and apply this amount of knowledge and discri- 
mination, it is not only necessary that he who devotes him- 
self to the care of the insane should pass his noviciate in an 
asylum ; or, in the active discharge of his duties, see his 
patients, as has been recommended, once or twice a-week; 
he must live among them ; he must be their domestic asso- 
ciate ; he ought to join in their pursuits and pastimes ; he 
ought to engage them in converse during the day, and listen 
to their soliloquies in the retirement of their cells ; he must 
watch, analyze, grapple with insanity among the insane, and 
seek for his weapons of aggression in the constitution and 
dispositions of each individual, and not in general rules or 
universal specifics. 

The next requisite is an establishment properly placed 
and constructed. The site of an asylum is rarely considered 
as of importance ; or, if any care be bestowed on the selec- 
tion, it is in reference to salubrity. It certainly is indispen- 
sable that the situation chosen should be healthy, that it 
should possess the advantage of a dry cultivated soil and 
an ample supply of water, that it should be so far in the 
country as to have an unpolluted atmosphere, a retired and 
peaceful neighbourhood, and yet be so near to a town as to 
enjoy all the comforts and privileges and intercourse which 
can only be attained in large communities. The evils 
arising from inattention to these and even to less obvious 



182 WHAT ASYLUMS OUGHT TO BE. 

considerations can scarcely escape observation, and have 
occasionally been proved by painful experience. The 
physicians in Paris have been forced to refuse baths, when 
clearly indicated, in consequence of the want of water. I 
am acquainted with asylums placed on ground so sandy and 
unproductive that common garden vegetables could not be 
raised from it, and the bare rock would have more liberally 
repaid the labours of the flower-gardener. I have likewise 
seen these institutions so surrounded by squares and streets 
and filthy densely inhabited lanes, that roofs and stone walls 
were the only objects visible from the windows, and all ex- 
tension of gardens or airing grounds was out of the question. 
But the locality in which the building is erected may be 
made to contribute to the cure of insanity, and to the en- 
joyment of those under treatment. If it occupy a dead 
insipid flat, the view is either bounded by walls, and if the 
structure be of one story only, according to the most ap- 
proved plan, it must always be so, or should the longing 
eye be permitted to catch a glimpse beyond, the horizon is 
limited and the scenery tame. Patients are not, in such a 
situation, so easily induced to take exercise, nor so much 
benefited by it, as when the surface is irregular, the land- 
scape varied, and the necessity for exertion and the exhi- 
laration which attends it are greater. If the building be 
placed upon the summit or the slope of a rising ground, the 
advantages are incalculable. To many of those whose in- 
tellectual avenues to pleasure are for ever closed, the mere 
extent of country affords delight; to. some the beauty of 
wood and water, hill and dale, convey grateful impressions ; 
to some the inanimate objects, the changes of season, the 
activity of industry, the living and moving things which pass 
across the scene, form a strong and imperishable tie with 
the world and the friends to which the heart still clings ; to 
others the same objects may remind of freedom, its value, 
and the price by which it may be purchased ; to all a sue- 



WHAT ASYLUMS OUGHT TO BE. 



183 



cession of new and varied and healthy impressions must be 
imparted. 

Wherever the institution is situate, it ought to be con- 
structed with a direct reference to the comfort and the cure 
of the inmates. It would be preposterous to lay down rules 
as to the precise plan to be adopted in the erection of an 
asylum. But there are certain principles applicable to every 
case, which cannot properly be omitted. Economy in space 
is a sad extravagance in medicine and medical attendance 
and human life. It is not enough that the public rooms 
should be large and lofty, the sleeping apartments should be 
proportionally larger. If it be desirable that the lunatic should 
enjoy a quiet and refreshing sleep, it is indispensable that his 
breathing be not disturbed by foul confined air, or by the 
effluvia which is concentrated, as it were, in small ill-ven- 
tilated cells. And putting out of view the classification 
which ought to obtain in the daily pursuits and pleasures of 
the inmates, there exist urgent reasons for building a retreat 
for the insane in such a manner as to allow an extensive 
system of night classification to be put in operation. The 
peculiarities and necessities of the furious, suicidal, and 
fatuous must be provided for as carefully during the one 
season as the other ; so that, although the external beauty of 
the whole edifice ought not and need not to be sacrificed, it 
is absolutely necessary that a large portion of it should be 
built of one story only. In this are to be placed all those 
who might be injured or who might injure themselves, if 
lodged in a house constructed in the ordinary way. The 
paralytic will not then be endangered in ascending or de- 
scending stairs, the furious will have fewer opportunities of 
wreaking their reckless violence or vengeance, and the 
suicidal will be debarred from one of the most easily acces- 
sible means of gratifying their ruling propensity. In the 
older establishments, where stairs could not be dispensed 
with, accidents were guarded against by the use of iron 



184 WHAT ASYLUMS OUGHT TO BE. 

screens or cages surrounding the exposed part of the ascent, 
which answered the purpose in view very imperfectly, and 
suggested the most gloomy and painful thoughts, alike in 
those who meditated evil and in those who were innocent 
of such designs. By placing individuals who cannot be 
trusted elsewhere in a cottage, the windows of which are 
only a few feet from the ground, all danger is obviated, the 
presence of attendants and the employment of mechanical 
precautions rendered unnecessary, while free egress to the 
open air, to the grounds or gardens is enjoyed by the 
patient. 

While it is very clear that the arrangements for the diffe- 
rent sexes must be varied according to their respective 
wants, occupations, and recreations, it is likewise necessary 
to be borne in mind, that in the case of a public asylum, a 
larger portion of the building should be allotted to females, 
as their numbers almost always preponderate. The conti- 
nental establishments are all constructed on this principle. 
" Mais," says Brierre de Boismont, in writing on the subject, 
" au lieu de construire les sections pour vingt malades, on 
les ferait pour trente, a cause du plus grand nombre des folles 
alienes." On the minute details of the internal economy, it 
is not my purpose to enter : but two provisions for the 
health and comfort of the inmates must be adverted to. The 
first of these is an ample supply of baths. At certain seasons 
they should be employed to secure the cleanliness of all the 
patients : and during the whole year they are absolutely 
required, in the treatment of particular cases. Leaving the 
question of the propriety of using the plunge-bath, open for 
discussion, I would strongly recommend, that in addition to 
the customary complement of hot, and cold, and shower-baths, 
every asylum should possess the means of directing a quan- 
tity of cold water upon the head, while the body is immersed 
in a warm-bath. When moral treatment cannot, and bleed- 
ing and tartar emetic ought not to be resorted to, I have seen 



WHAT ASYLUMS OUGHT TO BE. 



185 



the most frantic and ferocious maniac restored to tranquillity, 
by the discipline suggested. The second provision is the 
erection of what may be styled self-acting, or cleansing wa- 
ter-closets, in all convenient parts of the house and grounds. 
The water may be introduced in various ways, either by 
the valve being raised by the opening of the door, by the 
pressure of the feet on the floor, or of the hands on the seat ; 
but by whatever arrangement effected, the principle and the 
object are the same, to render the process of purification alto- 
gether independent of the habits or inclinations of the 
patient.* 

It contributes greatly to the quiet of an asylum during 
the night, and to the remedial effects of sleep, if the noisy 
and furious can be placed at a distance from the other 
classes of patients. This is the first, and perhaps the most 
important step in classification. In the immense barracks 
which it was the fashion formerly to construct, it can only 
be accomplished by removing the turbulent patients to some 
remote and unoccupied wing, or by erecting cells distinct 
from the main body of the house. Modern establishments, 
instead of presenting an almost interminable succession of 
wards and corridors under one roof, generally consist of a 
number of separate houses, in which the patients are distri- 
buted according to their dispositions and the features and 
stage of their disease, and one of which is of course appro- 
priated to that class of which we have spoken. This excel- 
lent arrangement exists at Ivry, at Mr. Warburton's asylum 

" It is almost needless to add, that all suitable expedients should be 
had recourse to for the purpose of sufficiently ventilating every chamber, 
corridor, and corner of such an establishment. For copious directions 
of the best means of effecting this, I would recommend the perusal of 
Sylvester's Philosophy of Domestic Economy, and Dr. D. B. Reid's 
Brief Outlines Illustrative of the Alterations in the House of Com- 
mons. 



186 WHAT ASYLUMS OUGHT TO BE. 

near to London, and at Burlington asylum, under the super- 
intendence of Dr. Fox.* 

When the patients sleep in separate apartments, it appears 
to be a great improvement on the old plan that these should 
open into a long and spacious gallery. This, besides sub- 
serving to ventilation, may be used as a common hall, as a 
work-room, as the place where the night keeper or nurse 
may watch, and for various other purposes equally useful. 
But where the interests of paupers, or of such individuals 
as cannot afford to provide a servant, are to be considered, 
dormitories appear to be in many respects preferable to cells. 
In giving this preference, it is, of course, supposed that the 
rooms set apart as common sleeping places are large, cheer- 
ful, well aired, that classification is rigidly attended to, that 
the beds of the patients are wide apart, and that a keeper 
either watches or sleeps beside them. The presence of this 
person is even of greater consequence than an unvitiated 
atmosphere, as it yields the pleasure of society and protection, 
as it prolongs the influence of moral training into the silent 
watches of the night, To many the step, the admonition, even 
the presence of such an attendant acts as a powerful restraint; 
some ebullition of ill temper, some wild fancy or horrible 
delusion is arrested : the timid and superstitious are inspired 
with confidence and courage, and sleep in peace, while the 
docile and affectionate derive absolute delight from the 
attentions of such a friend. The real or imaginary wants 
of all are thus supplied. How often may the bitter cry or 
earnest supplication, which is heard echoing through the 
corridors of an asylum during the night, be for a drop of 
water to appease the burning thirst of passion, or for some 
friendly voice to dispel the self-created horrors of a distem- 

* Combe, Physiology applied to Health, &c, fifth edition, p. 427. 
Minutes of Evidence taken before the Select Committee, &c , 1828, 
p. 5. 



WHAT ASYLUMS OUGHT TO BE. 187 

pered or remorseful conscience. More than this, a paroxysm 
of insanity or of some other disease is often developed during 
the night, which, raging unnoticed and unresisted for hours, 
either destroys life, or renders all previous and subsequent 
treatment unavailing ; whereas had a keeper been present, 
which, unless dormitories exist, he cannot be expected to 
be, these evils might have been prevented or mitigated 
These wards, or at least such of them as are inhabited by 
those who from their malice and recklessness are most likely 
to attempt fire-raising, and who from their imbecility are 
most likely to suffer from it, ought to be fire-proof. This 
plan has been adopted in Mr. Drury's excellent asylum, 
Glasgow, and at once secures valuable property, and, what 
is of infinitely more value, the lives of the patients from 
danger. The French asylums are now principally built of 
one story ; and this is done, as I have stated, to avoid the 
possibility of accidents, or attempts at suicide being sug- 
gested by the height from the ground, and to prevent the 
success of the attempt should it be made. In these cases 
the windows are likewise of the cottage fashion, and formed 
of iron, which prevent escape without appearing to do so. 
Among other precautions, and especially where solitary 
cells are used for the furious, and no personal restraint is 
resorted to, the walls should invariably be padded with 
wool or cotton or some soft material, an expedient which 
precludes the possibility of any injuries being inflicted by 
running the head against the walls, which is a common 
mode of mutilation. 

Many of the old institutions were either wholly or in part 
constructed without fire places, stoves, chimneys, or any means 
of affording warmth to their inmates. This proceeded from 
a fear for the safety of the building. The lunatic who could 
scarcely be trusted with a fire during the day in the presence 
of his companions and keeper, and even when guarded by an 
ample grating, could not expect such a luxury in his cell or 



188 WHAT ASYLUMS OUGHT TO BE. 

bedroom during the night. It is not, however, to be regarded 
merely as a luxury. In consequence of a great fall in the 
temperature, aided probably by the lethargic habits and 
condition of the nervous system in lunatics, limbs and lives 
have been lost. The fear of conflagration has so far subsid- 
ed, and the public halls and parlours are in almost every case 
sufficiently warmed. But the sleeping apartments are still 
as cold and injurious to health as ever. And the lunatic 
now passes suddenly from the common hall, where he has 
enjoyed a heat as high as 70° or 80° during the whole day, 
to his cell, where the thermometer indicates the freezing 
point. This partly explains the great mortality in some 
asylums, and is eminently unfavourable to the recovery of 
the tone of the nervous system. How is it to be remedied? 
It is quite clear that although it may be preposterous to 
conclude, as was formerly done, that any great number of 
lunatics are so destructive, suicidal, or idiotic, as to set fire 
to the house in which they live, their custodiers must act as 
if they were, and devise a plan which shall yield them suffi- 
cient warmth, and be compatible with the safety of all around. 
There are three modes of doing this : by heated air, by steam, 
and by the circulation of boiling water. Without comment- 
ing on the advantages of the two first it is enough to say that 
the third mode appears to be preferable. The apparatus by 
which this is effected consists of a furnace connected with a 
boiler or coil of pipes in which the water is heated, and two 
series of pipes, by one of which the hot water is conveyed to 
all parts of the building, whatever may be its dimensions, 
imparting its heat as it flows along : by the other the water 
is returned to the boiler to be again heated and again circu- 
lated. These pipes may be carried along passages, introduced 
into sitting and sleeping rooms, and in such a manner as 
neither to be seen nor to be accessible to the patients. This 
plan is completely adequate to the end in view. The degree 
of heat produced can be regulated, is equable, and does not 



WHAT ASYLUMS OUGHT TO BE. 189 

alter the qualities of the air. The plan is likewise economi- 
cal for, after deducting the first outlay for pipes, which, 
although considerable, must greatly increase the value of the 
house as property, the current expense of heating a large 
building, capable of accommodating several hundred patients, 
is said not to exceed that of a common fire. It is, further, 
perfectly safe, and affords a genial warmth to the body of 
the lunatic without afflicting or irritating his mind by the 
distrust implied by the iron-grating, and other provisions 
employed to keep him at a distance from the fire-place. 

As a means of attaining the same object, the clothing of 
lunatics should be rigidly attended to. One great difficulty 
has generally to be contended with in arranging the details 
of this part of the domestic economy of an asylum. Whether 
we have to act for the poor or the rich the supply of clothes 
is inadequate : in the one case from the poverty or parsimony 
of the parishes, public bodies or individuals by whose charity 
they are supported : and in the other, from the supposition 
very frequently entertained, even by compassionating friends, 
that anything is good enough for a madman, who cares not 
for cold, and attends neither to comfort nor decency. I have 
shewn that this supposition is directly at variance with the 
truth. There must accordingly be an attempt made to pro- 
vide, not only warm and clean clothes, but changes of these 
adapted to the different seasons and variations of temperature 
and weather, and resembling, as closely as possible, those to 
which the individual had been accustomed; and, if practi- 
cable, there should be no uniformity of costume. It may 
have advantages, but it reminds of the workhouse, the prison, 
the galley-slave. 

Let us pass to the exterior. We must not rest content with 
airing-grounds. However extensive the area of these may 
be, and in certain establishments they are as ample as can 
be expected, they are, in reality, nothing more than narrow 
strips of sward or gravel surrounded by high walls. They 
present all the characteristics of imprisonment without one 



190 WHAT ASYLUMS OUGHT TO BE. 

of its alleviations. Within them a patient may walk his 
weary round for half a century without obtaining a glimpse 
of the world he has left, with no other objects to gaze upon 
save his miserable companions in misfortune below, and the 
interminable blue sky above. The expedients to relieve the 
monotony of such a scene are interesting. A patient under 
my own charge walked fifteen miles per day for a consider- 
able length of time in making the circuit of one of these 
courts ; another counts the stones in the wall ; a third watches 
the appearance of faces at the windows by which the court is 
overlooked. These places should be planted, have a foun- 
tain ; a portion of ground prepared as a bowling green ; they 
should be stocked with sheep, hares, a monkey, or some other 
domestic or social animals. In the spirit of a bygone period, 
it may be objected that the trees will be uprooted or used 
for gallows, that the bowling-green will be destroyed, the 
pets killed. But in any institution where such arrangements 
exist the principles of classification would likewise be recog- 
nised, and no lunatics, whose dispositions or delusions prompt 
them to commit such acts, would be admitted to this part of 
the establishment, or, if admitted, would be under the eye 
and guidance of the attendant : one of the most useful duties 
of a keeper being to render many enjoyments accessible and 
innocent by his presence and superintendence, which in his 
absence might be dangerous. The courts and promenades 
in Salpetriere, containing a thousand lunatics, have been 
planted for twenty years, and no suicide by suspension has 
taken place. The grounds at Charenton, Rouen, Sonnen- 
stein, &c., are laid out in the same style, and have neither 
been destroyed, nor have they proved inconsistent with the 
safety of the patients. But, besides, or in default of these 
minor attempts to enliven the aspect of these prison-yards, 
the centre should be raised as a mound or terrace, so high 
only as will give a wide and animated horizon but so low 
as will prevent any intercourse taking place with the inhabi- 
tants in the immediate neighbourhood. The patients are 



WHAT ASYLUMS OUGHT TO BE. 191 

thus, in a certain sense, restored to the world while reaping 
all the benefits of seclusion. They have an immense num- 
ber of new and pleasing and yet unexciting impressions 
conveyed to their minds, all calculated to suggest healthy 
trains of thought, all foreign to their morbid feelings, and 
furnishing some materials for reflection more allied to sanity 
than the ravings of their fellow -prisoners, or the glare of a 
dead wall. All these changes might be wrought without 
expense and with great moral benefit by the lunatics them- 
selves. What lunatics can accomplish by mere manual 
exertion may be learned from the following quotation : " The 
supply of water for the establishment, Hanwell, having been 
principally derived from the canal, inconvenience was often 
experienced in dry weather from its insufficiency : a very 
powerful spring had been found upon the premises by boring 
to the depth of nearly three hundred feet. A large reservoir, 
to contain the daily overflow, which was sufficient for the 
consumption, was found to be the cheapest mode of render- 
ing this spring available to the institution. At the sessions 
held last April, the court granted L.650 for that purpose, the 
sum at which the cost of it was estimated. Your committee 
have to state that it is now finished. The excavation is thirty 
feet deep, and forty-five feet in circumference. This work 
having in a great measure been accomplished by the labour 
of the patients, the cost has fallen considerably below the 
estimate, so that instead of L.650, the sum voted by the court, 
your committee have only to call upon the treasurer for the 
county for L 318, 2s. lOd. for that purpose."* There are la- 
bourers and gardeners and masons in every asylum, or should 
there not, there will always be found men with sinews sufficiently 
strong to carry earth and lay turf, and this is all that is wanted. 
And why, under such circumstances, should not lunatics be 
taught to do these and many other things ? There is besides 

* Sixth Report of the resident Physician and Treasurer of the 
Hanwell Pauper Middlesex Asylum. 1837. ?. 4. 



192 WHAT ASYLUMS OUGHT TO BE. 

in such an undertaking a definite object in view, and this 
invariably facilitates all operations in which lunatics are 
concerned. Intrust the most irreflective with a frivolous 
commission, or with some piece of work which is evidently 
prescribed as an occupation, and of no utility either to him- 
self or others, his pride is offended, the task is performed 
reluctantly and without interest, and the moral effect is lost. 
But in employment, the object and the utility of which is 
explained and understood, the great majority of patients 
will, at a certain stage of the disease, cheerfully engage. 
This is a strong argument for enabling each to pursue his 
own profession, so far as is practicable. But care should be 
taken in the selection of the kind of occupation, for an 
egregious and irremediable error may be committed in 
allowing madmen to engage in an employment about which 
their mind is deranged.* 

It must be confessed, however, that the airing grounds, 
as at present laid out, are great improvements upon the 
dark ill-ventilated halls which used to be the only places for 
recreation and exercise. Light and air are no longer con- 
traband, although they are still severely taxed. But in 
addition to the changes of which mention has been made, 
there ought to run along the walls of these courts, or through 
their centre, covered galleries, which, while they in the 
former case prevent escape, protect from heat or rain, and 
allow of exercise being taken in defiance of either. Where 
the situation of the asylum affords a commanding view, such 
as at Charenton, these alleys are favourite places of resort, 
and during summer are frequented not only by the idle 
saunterer or sentimental gazer, but are crowded with read- 
ing-desks and drawing and work tables, and by all those 
who have the wisdom, or are instructed, to associate the 
pleasures which the beauty of nature affords with the ordi- 
nary and obligatory occupations of life. But even were 

* Spurzheim. Physiognomical System, p. 568. 



WHAT ASYLUMS OUGHT TO BE. 193 

these yards modified in the manner proposed, we must not 
rest content. A wider sphere for physical exertion and 
means for multiplying pleasureable sensations must be pro- 
cured. Gardens, grounds, farms must be attached to each 
establishment, and must be cultivated by or under the 
direction of the lunatics. Many of the existing establish- 
ments have from thirty to forty acres in their own hands ; 
and at Bicetre the least productive part of the farm has been 
converted into a bleaching-green. In the same institution, 
now under the able superintendence of Ferrus, there are 
150 patients constantly employed in levelling, masonry, 
digging, joiner's, blacksmith's, and even carpenter's work. 
I have before adverted to the benefits of engaging every 
patient in some suitable occupation, and shall now only 
allude to the principles which ought to regulate all attempts 
to induce them to take such a step. In many respects an 
asylum should be assimilated to an infant school. The 
mind has been reduced by disease to the state of childhood ; 
it displays the same waywardness, the same impatience of 
control and of compulsory labour, the same capricious desire 
for the gratification of the most urgent motive, and some- 
times the same stubbornness and ill-temper. But while 
there exist similar difficulties, other characteristics of youth 
are present, which may be employed in this instance as well 
as in education to communicate strength, or to awaken 
powers that perhaps require only a proper stimulus to 
assume their legitimate exercise. There is often docility, 
the gratitude inspired by habitual affection, the sense of 
justice which fair dealing will enlist on the side of health, 
and too frequently that simplicity, depending on diminished 
intelligence, which permits the patient to be cheated by 
amusement or active employment into health and serenity 
of mind, as the learner is cheated into a knowledge of im- 
portant truths or practical facts by means of a game at 

K 



194 WHAT ASYLUMS OUGHT TO EE. 

romps, or some merry carol. Place the undertaking of 
acquisition, in the one case of health, in the other of infor- 
mation, before the parties as a duty, a task, and as a duty 
■which must be performed, a task which must be learned or 
punishment and disgrace will follow, and the probability is, 
that in a majority of cases the proposal would be spurned, 
or would excite disgust or insubordination, which even the 
infliction of the threatened punishment would fail to remove. 
Nor need we wonder at this result ; it is children of different 
ages that we treat. Certain individuals might be awed, or 
coaxed, or bribed into compliance : that is, the point is 
carried by an appeal to the sense of fear, to vanity, or to 
the wish to possess some desirable object, and not in virtue 
of the reasonableness of the request, or the convinced under- 
standing of the party. These modes of carrying our plans 
extensively into operation are occasionally unavoidable. 
But let those who have tried to teach children by these 
methods, and who, departing from such a vicious discipline, 
have endeavoured to make what is valuable attractive, and 
what is attractive valuable, declare the comparative results, 
and their experience will be found to coincide exactly with 
the recorded effects of compelling the insane to do what is 
necessary and proper, and of inducing them voluntarily to 
do the same things, by connecting them with their comfort 
and happiness. No argument against the system pursued 
in infant schools is valid, because in some instances it fails 
to unfold the embryo mind ; nor should an objection to the 
proposition advanced be founded on the inapplicability of 
persuasion and moral training to certain lunatics, inasmuch 
as in the great majority of cases they bring peace and plea- 
sure. If the infant school teacher be efficient, he discri- 
minates not only the talents but the dispositions of his 
pupils, and metes out instruction of a nature and a quantity 
and in a manner suited to both : and if the superintendent 



WHAT ASYLUMS OUGHT TO BE. 195 

of the insane knows his duty, he likewise adapts the impres- 
sions he is desirous of conveying to the condition of the 
mind which he is solicitous to restore. No superintendent 
or keeper would be so grossly ignorant as to force a man to 
dig who was disposed to weave, and none ought to be so 
ignorant as to overtax the weakened or already burdened 
mind by long sustained attention to either. The comparison 
between the enlightened treatment of lunatics and the prin- 
ciples of infant teaching proceeds no farther. In the infant 
school one invariable mode of tuition is applied to all, whe- 
ther judicious or not is not here the question ; in an asylum, 
while general principles are held in view, a different plan 
must be pursued in leading every individual, or at least 
every class of individuals, to the point at which we desire 
to arrive. We may be justified in giving the stern tones 
of command to our voice, when it is necessary to govern 
the proud or venerative maniac, but it would be absurd and 
cruel to do so in order to guide the timid, the affectionate, 
or the irascible. 

The deception is virtuous, when by an imagined pursuit 
of pleasure we lead on the mind unwittingly in the pursuit 
of sanity ; but if a higher motive can be used, if reason can 
be made to assist in its own restoration, no deception, how- 
ever pure and praiseworthy the intention, should be resorted 
to. Even in intercourse with the insane, honesty is the best 
policy. 

There is a rule in many asylums, that when we have 
succeeded, when the pauper lunatic, in obedience to our 
injunctions, has engaged in some useful occupation, he shall 
receive no wages for his labour. I think the rule in every 
way a bad one. It says, in other words, he shall have no 
interest in what he does. " Mais," says a kind and judicious 
friend to the lunatic, "nous le repetons, il faut remunerer 
l'activite par une recompense quelconque, par un leger 
salaire, une plus grande liberie, de plus beaux habits. La 



196 WHAT ASYLUMS OUGHT TO BE. 

plupart des alienes aiment le tabac. On f'era ce besoin an 
profit du travail."* There can exist no doubt but that an 
establishment is fully entitled to the proceeds of the labour 
of all those supported upon charity, and even of those who 
pay board. In many places these proceeds are considerable, 
and constitute a part of the annual income of the house, 
one of the means, in fact, whereby its beneficence is main- 
tained, and its benefits extended. In 1886, the proceeds of 
work done by lunatics amounted in the Dundee Asylum to 
L.200, and in that at Armagh to L.250. It would be indis- 
creet to sacrifice this, it may be argued, and preposterous 
to stipendize those who can want for nothing, and who very 
often neither know the value of money, nor how it can be 
'converted into gratification. But this is not the principle at 
stake, this is not the bearing of the question upon which we 
would stamp the stigma of error. Every one will admit 
that the lunatic has no claim on the asylum, where he is 
cherished and supported, to a compensation for his earnings ; 
that the amount of these are as nothing in liquidation of the 
debt he owes for the peace and protection and chance of 
recovery which he enjoys ; and that it would be ridiculous, 
and might be dangerous, to inculcate upon him that he has 
any such claim. The gravamen lies in the declaration, 
that he has, and can have, no interest in, or reward for, his 
daily occupations. To tell the madman, as an encourage- 
ment, that although he can expect no reward or indulgence 
for what he does, still the inducement of being improved by 
labour ought to be to him a consideration paramount to all 
others, is to describe colours to the blind, sounds to the deaf. 
He cannot appreciate the temptation, for he will not ac- 
knowledge that he is ill, or stands in need of improvement. 
It will scarcely be denied that a man will do that best and 
most cheerfully, in which he has some real or fancied in^ 

* Briere de Boismor.t, A?;miles d'Hygiene,[tcm. xvi. 



WHAT ASYLUMS OUGHT TO BE. 197 

terest ; that if he expect honour, or ease, or remuneration, 
or the satisfaction of any desire, he will exert his powers 
more continuously and energetically than if he expects no 
results whatever. It is because the enforcement of such a 
rule divests labour of all those attractions, that I conceive 
it to be bad. Could we act upon all lunatics through higher 
motives than by wages or bribes or commands, it would be 
well, but the great majority of the worst cases, at least, are 
ceasing to be lunatics, becoming convalescent, before you 
can do so. As the minds of the lower orders are at present 
constituted, the most powerful stimulus is gain, and if by 
addressing ourselves to the propensity to acquire, we can 
subdue more violent propensities, or still the agitation of 
disease, it would be imprudent and unphilosophical to reject 
the aid of such an agent. Payments in money are not ad- 
vocated, although in certain cases they are found to be. 
strongly desired, and more desired and more irresistible 
than any other temptation ; but it is generally more conve- 
nient, and equally acceptable to the other contracting party, 
to pay in another manner. First, either better diet and 
clothing are given, certain coveted luxuries are awarded to 
the industrious patient, to which as a pauper he has no right, 
and which his board, if in a higher class, could not purchase ; 
or secondly, a portion of his earnings is set apart for his 
behoof, to be accumulated until restoration of reason take 
place, and to be then delivered to him to meet the exigencies 
of his dismissal. The first of these plans is chiefly appli- 
cable to the incurable and the most debased lunatics ; the 
second to those who are curable, or who retain sufficient 
intelligence and feeling to cherish the hope of reunion with 
their friends, who are gladdened by the sympathies and 
cheerful prospects which such a hope creates, and will 
struggle to co-operate in your designs for their welfare in 
order to gratify that hope. In both cases it would be wise 
to allow so much per cent, on all labour, the rate to increase 



198 WHAT ASYLUMS OUGHT TO BE. 

both according to the amount of work done and the spirit 
in which it is executed. Certain tasks and working hours 
should be appointed, otherwise the anxiety to win may frus- 
trate the whole scheme, by first exciting and then fatiguing 
all the powers. The patient must, of course, be acquainted 
with the conditions upon which he is solicited to engage in 
active employment, and a certain degree of choice permitted 
as to the kind of compensation most acceptable, and the 
period at which it shall be made. The discretion of the 
employer must decide whether compliance is justifiable, but 
after the bargain is concluded, the terms, although they 
refer to nothing more than an ounce of tobacco or a cup of 
tea, should be observed as sacred. Violations of such 
'agreements have often led to serious consequences. 

The kindness and expediency of the proposal to accumu- 
late part of the earnings of the curable insane, until their 
health be completely restored, can best be understood by 
considering the situation of such individuals when liberated. 
Supported by their parishes or by public benevolence while 
insane and confined, they lose all claim upon such resources 
by their dismissal, they pass from a quiet home, are thrown 
upon society pennyless, it may be without friends or a single 
being who will shelter or sustain them, incapable of engaging 
in their ordinary trade, and unable to obtain employment 
were they capable of undertaking it. This cannot fail to 
inflict misery, to threaten the still delicate tenure of health, 
and undoing all that care and kindness had accomplished 
to bring about a relapse. The remedy is self-evident. Let 
all institutions, where occupation is extensively carried on, 
tax the revenue derived from the articles manufactured, or 
saved by the services performed ; the amount of the tax to 
be expended in providing for the safety and support of 
patients after they have left the house ; the funds to be con- 
fided to themselves if trustworthy, or, what would be better, 
to responsible guardians. This is just continuing the sur- 



WHAT ASYLUMS OUGHT, TO BE. 199 

veillance and treatment for a longer time, and spreading the 
benefits of such institutions over a period and scenes more 
critical as to the permanence of health, than even the first 
weeks of convalescence. These suggestions are founded 
upon experience, and are sufficiently justified by what has 
long been the practice at Salpetriere, although there the 
distinct right of the lunatic to wages is recognized. The 
" Samaritan" societies proposed by Sir W. Blizard and, I 
believe, organized in London about forty years ago, had a 
similar object in view. The benevolent intentions of their 
founders were, however, confined to the support of the poor 
when discharged from the public hospitals. The necessity 
for such a provision is very urgent, and obvious to all fami- 
liar with the class of individuals received into these esta- 
blishments, or with their fate subsequent to their recovery 
and dismissal. But the case of the recovered but destitute 
lunatic is ten times more clamant ; he is not only without 
work, but the malady from which he has been relieved 
proves all but an insurmountable obstacle to his obtaining 
any, however well established his character for honesty and 
industry may be. 

Classification may proceed on various principles. There 
is first the very obvious ground for separation, the rates of 
board. The accommodation, the fare, the attendance re- 
quired for the rich, caunot be extended to the poor, nor is it 
necessary that it should. The pauper could not appreciate, 
nor prize, nor derive benefit from the refinement and delica- 
cies essential to the comfort, and instrumental in the recovery 
of the affluent. Most fortunately this arrangement, which is 
called for by the usages of society, is found to correspond 
with those higher and less artificial distinctions which are 
dictated by philosophy. The second principle to be recog- 
nised, is the stage of the disease. Common sense would 
indicate ; but common sense has not yet effected a separation 
of the curable from the incurable, and both of these from the 



200 WHAT ASYLUMS OUGHT TO BE. 

convalescent, that class of patients who may be said to havfi 
recommenced their existence, and to require the gentle and 
strengthening treatment bestowed on infancy. For the incur- 
able, little active interference is required : but much may be 
done to render them happy and contented, to reconcile them 
with captivity, and to enable them to pass the close of their 
dreamy existence in tranquillity. As a class, they are iso- 
lated for the behoof of others, that they may not prove 
injurious to those who are still capable of being influenced 
by moral impressions, and liable according to the nature of 
these impressions, to be confirmed in their alienation, to be 
afflicted with a still more intense form of mental disease, or 
to be restored to health. That evil has been done, and this 
is the principal point at issue, by ignorance of this fact may 
be gathered from Pinel. To the curable and convalescent, 
then, our greatest care ought to be consecrated. The object 
is to place them in the most favourable circumstances for 
the re-development of impaired, impoverished, or imperfect 
power. Unless classification be pushed farther than has 
hitherto been suggested, this object can never be attained. 
The third principle, and that next in importance, is, that 
these classes should be subdivided according to the character 
of the malady and of the dispositions of each individual. It 
is not enough that the furious should be separated from the 
docile, or the imaginative from the fatuous ; the mind of 
every individual should be carefully studied, its healthy as 
well as its insane bearings analyzed, and the relations which 
these may have with, or the influence they may acquire upon 
the. minds of others calculated, and groups formed in refer- 
ence to the result. The violent or malicious may often be 
confided with perfect safety to the acquisitive, or vain, or 
religious monomaniac. The affectionate and happy may be 
associated with the desponding and despairing, and the help- 
less idiot may become the adopted child of some mother 
whose only delusion is weeping for infants which she never 



WHAT ASYLUMS OUGHT TO BE. 201 

bore. A system somewhat similar to that here described is, 
I believe, pursued in the excellent asylum at Perth. But 
it may be carried farther ; and whole families may be formed. 
A vain idler may be intrusted to the tutelage or example of 
three or four industrious knitters or oakum teasers ; and be- 
ing encircled by temptations to exertion, and stimulated by 
the desire of rivalry, abstraction from the dominant idea is 
often the consequence. A contented, self-satisfied, and ac- 
tive minded maniac is joined to a timid, a lethargic, and a 
gloomy maniac, and seldom fails to communicate some portion 
of those qualities which it is our object to infuse. Ln a great 
majority of cases, the members of these small communities 
contract lasting attachments. The first step in giving efficacy 
to the principle under discussion, is a short and an easy one. 
The great affinities of gentleness, of docility, of despondency, 
of vehemence, &c, are readily perceived. But the nearer 
approaches to the complete working of the plan are more 
difficult, because generally impeded by the structure of asy- 
lums, the small number of attendants, and the inefficient 
assistance afforded by them, and above all, by the prevailing 
ignorance of the laws of the human mind, and consequently 
of those differences of disposition, upon a knowledge of which 
the successful application of such a principle must depend. 
Notwithstanding these obstacles, a little tact and manage- 
ment will bring together those who are fitted for each other's 
society. The fourth principle is a corollary to the last. It 
is based, however, rather upon the amount of cultivation 
which the mental powers and dispositions have received, 
than upon their nature. Our confederacies must often be 
constructed with a reference to the degree of education, the 
tastes, and pursuits, and manners of the parties. The unhap- 
piness which would flow from bringing the ignorant and 
brutal into constant and compulsory contact with the en- 
lightened and refined may be imagined. In acting upon 
this principle we are sometimes forced to violate a rule pre- 



202 WHAT ASYLUMS OUGHT TO BE. 

viously laid down. Wherever the poor lunatic has been 
veil educated, accustomed to the courtesies and amenities 
of good society, and retains amid his hallucinations, the feel- 
ings and tastes which characterize that condition, he should 
be raised from the grade of paupers, and placed among those 
who still cherish similar feelings and tastes. His degradation, 
his loss of caste may be fatal, while his elevation may prove 
curative, and is in perfect conformity with the spirit and aim 
of the principle now insisted. Wherever practicable, that is 
wherever the acquirements and deportment of the superin- 
tendent admits of such an arrangement, the well-educated 
and well-bred convalescent lunatic should reside and asso- 
ciate with their physician and governor. The advantages 
•of this have been before adverted to ; but it may be stated 
here, that besides many examples of the partial success of 
the plan, which might be quoted from the reports of asylums 
in this country, there is at present an excellent private esta- 
blishment in Paris, where about thirty patients take all their 
meals, spend their time, and pursue their occupations and 
pleasures in the company of their medical attendant. 

Much may be done in certain classes by an appeal to 
honour, to that conventional integrity and faithfulness which 
is more frequently the offspring of a dread of the world's 
censure, than a dread of the culpability of disingenuousness. 
yieu. who have long lived and acted under such a motive, 
may often, even during the access of frenzy, be guided by 
it. To a man of the world with confused notions of duty 
and virtue, but with a clear conception of the code of chi- 
valry, and an elevated opinion of the character which it 
becomes him to support, all doubt, all suspicion of the pos- 
sibility* of his breaking his word, of his doing that which he 
has promised not to do, will communicate intense pain, de- 
stroy all reciprocity of sentiment, confirm his delusions, and 
increase his malady. Whatever the supposed intentions of 
such a patient, personal restraint would be improper. Es- 



WHAT ASYLUMS OUGHT TO BE. 203 

quirol acting on this rule, trusted a military man who was 
determined on suicide with the means of destruction on his 
pledging his honour that he would make no attempt to use 
thein. He passed through the ordeal in safety, but not with- 
out a struggle. This was venturing far, perhaps too far, but 
when well assured of the strength and influence of this feel- 
ing, it would be wise and prudent to appeal to it in preference 
to resorting to harsh or compulsory measures. It may be 
turned to good account in classifying patients of the higher 
ranks, but the dangerous error should be carefully avoided 
of attributing a greater strength and influence to this feeling 
in lunatics than in sane individuals. 

The association of lunatics requires to be skilfully man- 
aged. But when classes have been formed in conformance 
to the mutual wants, and wishes, and dispositions of the 
parties, the system is at once beautiful and self-operating. 
There is no need of keepers to direct, and chide, and caution. 
Their presence is required to regulate the machine, but its 
motions are spontaneous. The little kindnesses of co-opera- 
tion and assistance go forward, the weaver plies his shuttle 
as vigorously, and the dance and song conclude the day as 
regularly as if a whip or a comfit were displayed. It is a 
mistake to suppose that, as a general rule, these bands should 
consist of patients of similar dispositions. 
- When once associated, there ought to be as much liberty 
as is consistent with the safety of the whole community, and 
just as much restraint as is consistent with the happiness and 
recovery of each of the members. By liberty I do not 
mean independence of authority, idleness, or even a mere 
exemption from strait jackets and fetters. There must be 
laws vigorously enforced, and industry, and rewards, and 
punishments, in an asylum, as in every other body. I 
would here, however, make a distinction, confining punish- 
ments to moral delinquencies exclusively, exonerating the 
offender from all penal consequences where the offence is 



I 



204 WHAT ASYLUMS OUGHT TO BE. 

clearly the result, the manifestation of his derangement. 
But by liberty I mean the power of gratifying every inno- 
cent propensity, every justifiable desire, of pursuing every 
object which is calculated to inspire present pleasure, or 
conduce to the ultimate re-establishment of reason. Be nig- 
gard of mere indulgence ; but you cannot be too extrava- 
gant of enlightened humanity. Many establishments have 
been condemned and ruined, by the occurrence of a case of 
suicide within their walls, or an attempt to escape proving 
successful. I never heard of one suffering any penalty for 
undue severity or restraint, if these fell short of absolute 
cruelty. Self-destruction under such circumstances, is pe- 
culiarly distressing ; but it cannot be construed as a proof of 
laxity of discipline, or of too great indulgence in the par- 
ticular case, nor as an argument against general lenity and 
humanity. The lunatic turns some of the very means 
employed to protect him against himself, to his own de- 
struction. This, however, cannot be prevented under the 
best management, unless chains and unfurnished cells be 
resorted to; and even then the security is not complete. 
Every object may be converted into a deadly weapon. 
Pieces of glass, rusted nails, worsted thread taken from the 
carpet, medicine, the very walls, may be so employed. 
Escapes, while every precaution should be taken to prevent 
them, in general prove nothing more than that great free- 
dom is enjoyed by the inmates of the asylum — greater by 
one degree only, than what they ought to enjoy. There 
sometimes, however, arises danger from patients being too 
kindly treated. From being obliging, useful, amusing, and it 
may happen from the very nature of their malady, individuals 
become favourites. Out of this favouritism grow indulgen- 
ces, exemptions from medicines, duties, or punishments, and 
the encouragement of delusions, lest contradiction should 
annoy or render refractory. It is certainly very difficult to 
avoid forming and practically shewing a stronger attachment 



WHAT ASYLUMS OUGHT TO BE. 205 

for those who trust, serve, and it may be, love you, than for 
those who bend every thought to irritate or destroy you, or 
circumvent your plans. The preventive or remedy for such 
partialities, is to be found in the judicious selection of ser- 
vants — in the employment of those only who perceive and 
feel, that the fewer the endearing qualities of the patient, 
and the farther he is removed from participating in the sym- 
pathies of the healthy mind, the greater are his claims upon 
those around ; or who in the administration of justice, or 
the distribution of favours, recognize a perfect equality be- 
tween the patient with one sound feeling, and the patient 
with many. An easier, and perhaps safer mode of inter- 
rupting such ties, is the frequent change of servants from 
ward to ward. This is practicable in large establishments 
only. The same expedient is strongly recommended in 
cases of relapse. Celebrated authors go so far as to say, 
that patients should never be attended during two attacks, 
by the same servant. No vestige, it is argued, of their 
former illness, should be allowed to appear; and accord- 
ingly, every object calculated to recall the impressions 
existing during its continuance should be excluded. Almost 
every one has heard of the unfortunate victim of the blue 
devils, who was first hunted from London, and ultimately 
from his native country, by the reappearance of these per- 
secutors, whenever he was surrounded by certain pieces of 
furniture. The visual deception was here associated with, 
and constantly excited by a real visual impression. Upon 
a similar principle is the change of attendants proposed. 
But it is doubtful how far it ought to b*e pushed, as the re- 
collections of the state of convalescence which took place 
under the care of the servant, must be more vivid than the 
recollections of the state of insanity, and in proportion to 
the vividness and agreeableness of an impression, will it prove 
beneficial or injurious. But this change is advocated upon 
still another ground ; that of the dislike which is supposed to 



206 WHAT ASYLUMS OUGHT TO BE. 

arise in the mind of those who have recovered from insanity, 
towards those who have been instrumental in the cure. This 
supposition is altogether erroneous and libellous to human 
nature. When the hand of the curator of the insane was 
armed with the lash, and when insult and the bastinado were 
prescribed as specifics, it is highly probable that the re- 
covered lunatic did regard his oppressors with loathing and 
detestation. But now when the insane are treated as human 
beings, there exists evidence that gratitude and esteem as 
frequently reward the kindness and care of their attend- 
ants, as in any other of the relations of life where such 
sentiments are likely to be called forth. Upon this ground 
then, a change of attendants cannot be justified. Indeed 
where kindly feelings are known to exist, or to have existed, 
they should be received as indications of the propriety of 
resorting to the original attendant. 

Many profound sophisms have been delivered as to the 
introduction of religious worship among lunatics. It has 
been argued that such exercises are addressed to the highest 
feelings of our nature, and bring before the attention the 
most awful truths — that they are eminently exciting, and 
consequently prejudicial ; and the aphorism has been quot- 
ed, that it is necessary to avoid all excitement ; that as no 
opportunity should be given for the irritation of the furious, 
or for the intimidation of the timid, neither should any plan 
be adopted which may tend to foster religious impressions 
in the superstitious. This opinion has been controverted by 
the assertion, that such an appeal is tranquillizing and con- 
solatory, and leads the enfeebled mind to the only source of 
strength and succour. One authority adduces examples of 
the efficacy, another of the evils of such an attempt. It is 
prohibited, because it sometimes causes insanity, or aggra- 
vates a predisposition to the disease : it is recommended, 
because it brings hope and peace to those who, although 
sane, are miserable. I regard the grounds of opposition 



WHAT ASYLUMS OUGHT TO BE. 207 

and advocacy as equally invalid. Upon certain forms of 
mental disease, religious teaching or ceremonies would act 
as a direct irritant ; upon others they would fall powerless ; 
upon a third class, such ministrations would operate as any 
otlaer novel scene or occupation which assisted in relieving 
the monotony of their mode of life ; while upon a fourth, 
their influence would be altogether benign, affording a le- 
gitimate gratification to healthy feelings, directing the mind 
from depressing, or agitating, to soothing associations, and 
tending to inspire with brighter and nobler hopes, which 
disease can neither darken nor quench, which will beam in 
on the troubled spirit amidst its gloomiest delusions, as clear 
and certain points of guidance, like shore-lights to the storm- 
bound sailor. Upon the discrimination of the patients to 
whom religious instruction is adapted, the whole question of 
its utility rests. To prescribe it as applicable to all cases, 
would be as wise as to seek for the elixir vita? ; and to ex* 
elude it because sometimes injurious, betrays a deplorable 
ignorance of the constitution and the wants of the human 
mind. I may, with all reverence, compare the employment 
to that of any other medicine. It must be regulated by 
the idiosvneracies of the patients, by the symptoms, the 
duration and the complications of the disease. No man 
entertaining this view, will establish public worship as an 
hospital routine duty, in which all must or may participate. 
It should be reserved for the few who can understand its 
meaning, who may be quieted by its solemnity, cheered by 
the prospects which it affords, attracted by the beauty of 
the service, or roused by the recollections which it calls up 
— the condition of each of these classes having been previ- 
ously examined and tested as to the extent to which such 
impressions may be borne, and may prove beneficial. It 
will be observed, that many are here proposed to be admit- 
ted to these rites, who cannot be expected to regard them, 
or be influenced by them as religious duty. The imagina- 



208 WHAT ASYLU3IS OUGHT TO BE. 

tive, the musical, the lethargic lunatic, are thus all included, 
because pleasure would be communicated, and a new and 
healthly direction may be given to their thoughts by the 
aspect and accessory circumstances of the assembly, in- 
dependently altogether of its sacred character. Many 
exceptions, however, must be made, and the pleasure de- 
rivable must not be chosen as the ground of admission. 
Those, in fact, who most ardently desire to join such meet- 
ings, and who pant for spiritual communion, are often those 
who are least fitted for it. They doubt or despair of their 
salvation, or their whole soul is in wild exultation at the 
prospect of the bliss which awaits them : or they have seen 
visions, or they prostrate every power before the conviction 
that they are incarnations of Deity, or of the angelic host. 
In such states as these, any act connected with religion, 
must generally contribute to promote and perpetuate the 
activity of the diseased feeling. I say generally, for where 
the reason remains intact, and the dominant emotions are 
terror, despondency, penitence for imaginary crimes, and so 
forth, a clear exposition of the promises of Christianity made 
to the understanding, in a clear and conciliating manner, 
sometimes acts as if miraculously. Such cases must be select- 
ed, and not experimented on. Under such circumstances, 
private religious instruction would be infinitely preferable 
to any public devotional service. It is somewhat singular, 
that this mode of conveying powerful impressions is scarcely 
at all resorted to in our establishments. Apart from all 
other considerations, it enables the clergyman to study and 
probe the wound he desires to heal, to know the dispositions 
he has to contend with, and to frame his exhortations, and 
to regulate his intercourse accordingly. In a promiscuous 
congregation this cannot be attempted. The propriety of 
such a mode of communication is strongly insisted upon by 
the English physicians, and even by some of those who 
express doubts as to the salutariness of public worship, or 



WHAT ASYLUMS OUGHT TO BE. 209 

entertain a decided opinion against its employment. This 
practice was at a very remote period, 1677, introduced at 
Betblcm, but for reasons which cannot now be ascertained, 
has fallen into disuetude. In order to take advantage of 
every impression which public worship is calculated to 
excite, it appears to be highly expedient that it should be 
performed on Sunday, in the manner to which the patients 
have been accustomed in health, and in some apartment 
consecrated to the purpose. Many objects are hereby gain- 
ed : the regular passage of time is marked, I have two 
patients under my care, who lost all conception of this, ap- 
parently from the want of a calendar : the nature of the in- 
stitution is recalled, and with that fact many of the thoughts 
of other years, which, as connected with an unimpaired 
state of mind, and the performance of a sacred duty, are 
generally serene and salutary ; sentiments of reverence and 
humility are engendered, and the hope of the return of the 
day is excited, and an anticipation of the same calm thoughts 
and recollections. " They all look forward to it with plea- 
sure," says Dr. Fox. I am disposed to urge the propriety 
of Sunday being observed in the same manner within as 
without an asylum for another, and what may be condemned 
as too much of a secular, reason. It is there a day of idle- 
ness and lethargy ; it is shortened as much as possible by 
indulgence in sleep, or prolonged by the uninterrupted 
sufferings of self-tormenting spirits: in short, all moral 
treatment is suspended. This monotony is very hurtful. 
To continue that regimen by which occupation is provided, 
and by which unhappiness is combated, by calling healthy feel- 
ings into play, some act of public worship would be essential. 
There are certain descriptions of madness in the treat- 
ment of which religion is indispensable. But in the employ- 
ment of such an agent, great difficulties occur, so great 
indeed, as to discourage the most zealous of its advocates. 
These consist in determining the modes in which its effects 



210 WHAT ASYLUMS OUGHT TO BE. 

may be best obtained. If its doctrines are taught to weak 
or perverted intellects, they may add to the confusion already 
existing; if its mysteries are brought prominently forwards 
they are apt to mingle with superstitious fears and delusions ; 
if its duties alone are commented on, the doubting and igno- 
rant may be left unsatisfied ; if preaching is the vehicle, the 
attention may be fatigued and exhausted ; if prayer, the sen- 
timents may be strongly affected. These suppositions are 
all obviously founded upon the injudicious use of such an 
agent. Men are surely to be found with discretion sufficient 
to avoid the extremes here indicated, and to select these really 
catholic truths upon which men of all sects and shades of 
opinion, and even men of all degrees of intellectual enlight- 
* enment and moral excitement, may agree, and from which 
the insane as well as the sane may derive comfort. Prayer 
and praise certainly appear to be the least susceptible of 
abuse. They are placed by their nature beyond the control 
of the pastor. Either as if dubious how far even an educated 
mind can be trusted in dealing with these for the behoof of 
lunatics, or in the spirit of their peculiar views, the philoso- 
phical and humane governors of the Retreat at York, have 
confined the religious service performed there to the reading 
of certain portions of Scripture. But that, under proper 
management, this department of mental medicine may be 
carried much farther, is proved by the statements contained 
in the Annual Reports of various asylums. " When they do 
attend," says Mr. Ricketts, " they are attentive generally, 
and well conducted ; so much so, that I have known when 
a paroxysm was likely to come on ; five or six minutes before 
prayers, the patient has been brought in, and he has had such 
command over himself, that the paroxysm has been check- 
ed."* " It was only about the beginning of 1833," I quote 
now the experience of the medical officers of the Dundee 

* Minutes of Evidence taken before the Select Committee, &c. 
1828, p. 45. 



WHAT ASYLUMS OUGHT TO BE. 211 

Asylum on the subject, " that a regular chaplain was ap- 
pointed ; and who ever has witnessed the preparation made 
by the patients for their appearance at chapel — the solemn 
demeanour and strict decorum observed during the whole of 
the service — the close attention paid to the words of the 
preacher — and one of the patients occasionally officiating as 
precentor with becoming propriety and tasteful execution — 
will contemplate the picture with feelings of the deepest in- 
terest,, and fondly hope that the swelling notes that delight 
the ear have proceeded from lips which God has touched : 
and the words listened to with such attention, have been 
embraced by those whose heart has felt the power of divine 
truth." " No class is excluded : and though there must ne- 
cessarily be some whose state of health does not admit of 
attendance, and some who are without the inclination — and, 
in this case compulsion is out of the question — yet upwards 
of three-fourths of the whole number regularly assemble in 
chapel ; and it is found that, in regard to those whose tem- 
per is the most restless, and who are the most easily excited, 
the solemn nature of the religious service has a wonderful 
effect in subduing their irritation, in calming their minds 
and composing their spirits, not only during the time of the 
service, but during the remaining hours of the day of rest."* 
The following is the result of my own observations : — " The 
effects in each individual are probably as different as in the 
members of an ordinary congregation, but the general impres- 
sion produced is that of reverence and order. In whatever 
spirit the simple truths announced to them may be received, 
the meeting is almost invariably distinguished by perfect 
decorum and propriety. The stocking and book are laid aside 
— the involuntary and incoherent exclamation is no longer 
uttered, or subdued into a whisper, and one of those who 
usually spurns the authority and rejects the entreaties of 

* Fourteenth Report of the Directors of the Dundee Lunatic Asy- 
lum, 1834, p. 7. 



212 WHAT ASYLUMS OUGHT TO BE. 

those around, kneels calmly and reverently down as if 
perfectly conscious of the majesty of the Being whom her 
more rational companions are uniting to worship. Where 
convalescence has advanced to a certain stage, or where 
observation has shown that a patient is trust-worthy, per- 
mission is given to attend church, of course under proper 
superintendence. This is done partly that the idea of im- 
prisonment may be eradicated, partly that reunion with 
society may be gradual, but chiefly that the mind may be 
strongly directed to those principles and duties, a knowledge 
of which renders mental exertion and the cultivation of in- 
ternal peace and harmony alike an obligation, a reward, and 
a blessing. No violation of the promises given previous to 
the grant of such permission as to the deportment and return 
has occurred. One individual, after a seclusion of thirteen 
years, during which she had never been permitted to go to 
church, was deeply affected, and wept on again joining in 
the service, but otherwise her behaviour was irreproachable. 
It would have been extraordinary and unnatural had no 
feeling been manifested, and this conduct was accordingly 
regarded rather as an indication of sound mind than of alie- 
nation.'** The practice of allowing patients to attend the 
parish church has, I perceive, been adopted in other places. 
" Prayers," says Mr. Ricketts," are read in my establish- 
ment every Sunday, to every patient capable of receiving 
religious instruction. The convalescents go to church ; some 
of the highest classes with my own family." " But in other 
cases," is the statement of Dr. Finch, " I have been so con- 
vinced of the utility of religious services, that many of my 
patients go regularly to the village church, &c."f 

* Report of the Directors of the Montrose Lunatic Asylum, &c. 
1835, p. 16. 

f Minutes of Evidence, &c. 1828. Evidence of Mr. W. H. Rick- 
etts of Droitwitch, Worcestershire, and of Dr. W. Finch of Salisbury, 
pp. 42-49. 



WHAT ASYLUMS OUGHT TO BE. 213 

Similar efforts have been made at Sonnenstein and other 
places on the Continent, and have been attended with similar 
success. But these attempts to administer consolation by 
means of religious ordinances, have been pushed much farther, 
and the results have been supposed to be proportionally great. 
Patients have been permitted to participate in the sacrament 
of the Lord's Supper, and have been recommended to direct 
their thoughts constantly to the contemplation of their moral 
condition as the only course by which health and happiness 
can be secured. How far any physician is justified in counte- 
nancing such measures as these, appear to be very doubtful. 
The first of them presupposes, I presume, a state of convales- 
cence in the communicant, such a state at least as admits of 
a clear conception of the nature of the rite and of the obli- 
gations which its celebration imposes. The great objection 
to which it appears open, is the excitement to which the 
mind is exposed by the imposing aspect and duration of the 
ceremony, and the mingled feelings of awe, and penitence, 
and hope to which it gives rise. The determination of the 
question whether the probable amount of good to be obtained 
counterbalances the certain amount of danger to be encoun- 
tered, must rest in each case on the discretion and judgment 
of the medical adviser : for to establish a general rule on the 
subject would be most unphilosophical and pernicious. I 
am, however, inclined to think that when patients have ad- 
vanced so far towards restoration as to be intrusted with such 
high and holy privileges, that they should not longer be de- 
tained in an asylum, but should be reinstated in society, and 
in the possession of rights, and the discharge of duties of an 
important but less exciting character. The second measure, 
although sanctioned by a few practical observers, is in direct 
opposition to every rule laid down for the regulation and 
tranquillization of the unhealthy mind. To occupy the at- 
tention in a sustained manner, with any powerfully affecting 
topic, is prejudicial ; but when the object is the. ultimate des- 



214 WHAT ASYLUMS OUGHT TO BE. 

tiny of the troubled soul itself, the disturbance, the despond- 
ency, the exultation necessarily ensuing from the particular 
view taken by the unstable intellect, or waiving this position, 
even the anxiety, the tumultuous struggle of hope and fear, 
roused in the coolest, and strongest, and purest mind by such 
a train of thought, must inevitably overthrow that equani- 
mity which it is the aim of all rational treatment to establish ; 
and create that internal conflict, and agitation, and intense 
feeling which it is equally the aim of all rational treatment 
to prevent or remove. Many, if not all the cases where in- 
dividuals incurably lunatic have expressed apparently clear 
ideas on religious subjects, and satisfaction that they had 
been led to the consideration of these, have terminated 
almost immediately afterwards in death, and cannot accord- 
ingly be admitted as evidence, either of the permanency or 
of the remedial efficacy of the impressions produced. If 
great caution ought to be exercised in dealing with the insane 
mind, still greater care is required in drawing conclusions as 
to the effects of such interference. 

It would be foreign to my present object to delineate the 
detailed application of the principles of moral treatment in a 
well conducted asylum ; but it is of some importance to 
point out certain fallacies which have misled the public as to 
the nature of the system pursued, and give to it an appear- 
ance of empiricism which it actually does not possess. They 
farther countenance the prejudice that the management of 
the insane depends upon a peculiar and mysterious tact, and 
is not founded upon a knowledge of human character. Thus, 
for example, the idea that an unanswerable argument or piece 
of pleasantry can eradicate a delusion, is altogether errone- 
ous. The most plausible case of this kind is that of the 
mechanician mentioned by Pinel. This person was haunted 
by the imagination that he was one of the victims of the Re- 
volution ; that he had been guillotined ; but the sentence 
having been reversed just at the moment the execution had 






WHAT ASYLUMS OUGHT TO BE. 215 

been completed, the judges in order to remedy, so far as 
possible, what had been done, commanded that the heads 
should be replaced on the respective bodies. In the confu- 
sion, two heads were transposed: the mechanician lost his own, 
but was provided with another, which he very much disliked, 
and which he attempted to prove was not his own property by 
saying, " look at these teeth ; mine were exceedingly hand- 
some, these are rotten and decayed. What a difference between 
this hair and that of my own head !" He likewise ima- 
gined that he had discovered the perpetual motion, and 
worked night and day in the construction of a machine on 
this principle. He often quarrelled with his companions on 
the subject of his head ; and one of them being instructed 
how to act, led the conversation to the miracle of St. Denis, 
who, it is said, walked about with his head under his arm, 
and kissed his own lips. The mechanician maintained the 
possibility of this : his opponent retorted, " madman that 
thou art, how could St. Denis kiss his own head — was it 
with his heels ?" This discomfiture is said to have restored 
him to reason. But here it is quite evident, that the six 
months' course of vigorous application to his business was 
more instrumental in the cure than the biting repartee. 
Equally undeserving of confidence is the belief in the effi- 
cacy of an acquiescence in the whim of the maniac, and the 
institution of some process to remove the evil complained of, 
it being acknowledged to be real. Esquirol advises this to 
be tried as a last resource. It is especially applicable to 
hypochondriacal maniacs, who imagine that they labour 
under disease, are devoured by animals, &c. The following 
examples are not intended to justify the practice, but will 
show to what cases it is applicable, and in what cases it has 
been supposed to prove successful. A woman suffered 
from pain on the top of the head, and believed that it was 
caused by an animal burrowing beneath the skin. She was 
for a time restored to sanity by an incision made in the 



216 



WHAT ASYLUMS OUGKT TO RE- 



spot, and the pretended extraction of an earth worm. A 
hypochondriac who believed that he had frogs in his stomach, 
is said to have been cured by a purgative, and the introduc- 
tion of one or two frogs in the night stool. But admitting 
that such instances are worthy of consideration, is it not 
more likely that the incision and the purgative were the 
remedial agents than the deception practised ? But without 
insisting upon such a construction, the plan is objectionable 
from its tending to foster the delusion, by suggesting, as 
often happens, under somewhat similar circumstances, that 
although one worm had been removed, others more deeply 
imbedded remained behind : and in the case of the hypo- 
chondriac, that before the expulsion of his full-grown enemies 
they had spawned, and that his malady was renewed by their 
growing progeny. 

Quackeries of a more marked character, and of a less 
innocent description, have at all periods in the history of 
mental medicine, obtained celebrity, shrunk from the test of 
experience, and ultimately been rejected. Any mode which 
is reputed to cure insanity instantaneously, or in the course 
of a few hours, may be looked upon with suspicion, when 
the nature of the remedy is concealed, and the mystery thus 
created employed as a means of enriching the discoverer. 
In our own country, in former times, lunatics were supposed 
to be cured in a single night, by sleeping in churches of 
great sanctity, or by a bath in particular springs. A Mil- 
anese physician cured all cases of mania in a given time, by 
chaining his patients in a well. The water was allowed 
gradually to ascend to the mouth, and when the maniac was 
in terror of being drowned his disease ceased. He was thus 
terrified into his senses. In our own country, and in our 
own day, a medical man has declared, that he has in his 
possession a remedy, which, when properly administered, 
will cure the most incurable maniac, and that in a few days. 
Mr. Lucett's method has received high sanction. In one 



WHAT ASYLUMS OUGHT TO BE. 217 

instance he received L.200 from the Board of Treasury, for 
the cure of a servant of the Duke of Kent. He professes to 
perform the cures attributed to him — miracles they deserve 
to be named — by the aid of kindness, a lotion applied to the 
head and the secret nostrum, before alluded to. A com- 
mittee of medical men was appointed to enquire into the 
facts of the case ; and their report shows, that mitigation of 
symptoms, and not cure, was the amount of Mr. Lucett's 
success— a mitigation which is within the reach of every 
practitioner, if he chooses to push the exhibition of a power- 
ful and unmanageable drug to a great extent — a mitigation 
which, although occasionally desirable, has not been proved 
to facilitate the cure of the patient, while it places his life 
in jeopardy. Mr. Lucett's success may be contrasted with 
his pretensions, as narrated by one of his patrons. " The 
third experiment was upon an idiot, without the powers of 
speech, or the use of his limbs, and blind from pressure on 
the optic nerve. Within seven weeks he was restored to 
reason, speech, sight, and the use of his limbs." The only 
commentary which such a relation requires, is that all other 
physicians would find it nearly as easy a task to imbue the 
dead with life, as to raise such a being as that described to 
intelligence. 

It may be laid down as a general rule, that all mystery 
is foolish and hurtful. It creates a suspicion that there is 
something which requires to be concealed. It inspires dread 
— the very opposite of the feeling which it is desirable should 
be entertained both by the public and the patients. It is 
allied to quackery, as founded upon the pretence of superior 
or secret knowledge, or upon the existence of proceedings, 
the nature of which it would be unsafe or imprudent to dis- 
close. For a long period English practitioners arrogated to 
themselves the possession of some specific which enabled 
them to cure a greater number of lunatics than their con- 
tinental rivals. This secret and all powerful remedy, in 

L 



218 WHAT ASYLUMS OUGHT TO BE. 

order to bolster up their own reputation they had the sel- 
fishness and cruelty to conceal. There was in fact nothing 
to reveal. Pinel exposes this compound fraud and folly by 
detailing his own benevolent views as to the moral treat- 
ment of the insane, and by proving that the boasted secret 
consisted in nothing more than the judicious application of 
these. 

On the continent, a very powerful movement has been 
made to place the treatment of lunatics upon a true basis ; 
and were we to believe some of our periodical writers, the 
improvements already effected, infinitely exceed any thing 
which has been attempted or thought of in this country. 
For instance, a writer in the Medical Gazette favours the 
Ipublic with the following relation and remarks : " The 
French certainly carry their treatment of the insane to a far 
higher pitch of refinement than we do. The idea of giving 
a ball in a lunatic asylum, may startle some of our mad 
doctors ; but what think they of the following precedent. 
On the 7th instant, May 1835, the females of Salpetriere 
were treated to a grand ball. The insane ladies themselves 
were entrusted with the getting up of the entertainment. 
They adorned the ball-room with festoons, garlands, and 
devices ; and in the midst they crowned with immortelles, 
the bust of Pinel, the liberator of the insane from the old 
system of cruelty and terror. The dancing, it is said, went 
off with charming effect ; the students, intern and extern, 
did the honours ; and the festivity was kept up to an hour 
sufficiently advanced to satisfy all parties, who, to do them 
justice, were indefatigable in their efforts to please and to be 
pleased. It should be added, that the gay scene, (which 
was appointed and arranged with the most serious object) 
has been generally attended with good results : it served 
admirably to fix and amuse the minds of the patients ; and 
several who laboured under melancholia were much divert- 
ed for the time from their imaginary woes. M. Esquirol 



WHAT ASYLUMS OUGHT TO BE. 219 

some years ago tried this method with success ; but it is to 
M. Pariset, the physician to Salpetriere, that the credit is 
due of having so happily ventured on its repetition in the 
present instance."* Now, in place of this statement creating 
any astonishment in the minds of those intrusted with the 
care of the insane in Britain, they will experience regret and 
surprise, that what they have done for the behoof of their 
charges should be so little known even to their professional 
brethren. Dancing, both as a physical exercise, and a6 a 
recreation, has been introduced, and with excellent effects, 
into many well-regulated British asylums ; and to speak 
from personal experience, were the foregoing account di- 
vested of some of the embellishments — the festoons and 
immortelles — it would very correctly describe what takes 
place, and has for years taken place, once every week in the 
establishment under my care. So that while I would speak 
with veneration and gratitude of all that Esquirol and 
Pariset have advised or accomplished, it is but justice to 
our national discernment to say, that we have already 
reduced to a system what they have only tried as an experi- 
ment. I cannot speak so decidedly as to the introduction 
of dramatic representations as a means of cure. The attempt 
has been made at Charenton unsuccessfully, at Copenhagen 
without injury ; but the inhabitants of this country mani- 
fest during health so little taste for such spectacles, and 
depend so little upon them as sources of amusement, that it 
would be injudicious to resort to them in order to arouse, 
or attract, or amuse the insane, while we have so many bet- 
ter modes of abstraction at our disposal. 

In front of the philanthropical enterprize in favour of the 
insane in France, may be placed, Drs. Falret and Voisin. 
They have long studied mental disease in the best school ; 
they have long cherished the desire of putting the prin- 

* London Medical Gazette, May 23, 1835. p. 288. 



220 WHAT ASYLUMS OUGHT TO BE. 

ciples dictated by humanity and philosophy to the treatment 
of the insane, to a fair and full test, and they have now em- 
barked their whole fortune and hopes of prosperity in the 
experiment. They possess a large domain of about sixty 
acres, partly farm, party ornamental garden, situate in one 
of the many picturesque villages in the vicinity of Paris. 
From many points in their enclosure, the whole of the 
surrounding country is visible, while the bustle and annoy- 
ances of the metropolis are shut out. The banks of the 
Seine being undulated, every walk and turn presents a new 
aspect of the natural panorama. Fertility and beauty are 
constantly before the eye ; the luxuriance of a rich soil, the 
products of human skill. Within, the resources are equally 
great. The extensive grounds afford constant employment 
in the open air. Detached buildings render a scientific and 
rigid classification easy ; spacious apartments contain all the 
ordinary means of amusement, music, billiards, &c, and no 
appendage of which reminds the inmate that he is mad or 
not trust-worthy. In addition to these excellent arrange- 
ments, there is the constant superintendence of two humane 
and enlightened physicians, the society of their families, 
accommodation for the patients' friends, should their pre- 
sence be deemed expedient, the active administration of 
every moral agent, and the main spring of all, gentleness and 
affection. 

As an additional instance of the progress of sound princi- 
ples in France, and as an example of what an asylum for the 
upper ranks ought to be, I make the following quotation 
from the valuable work of Dr. Combe on " Physiology 
applied to Health and Education." " The celebrated and 
benevolent Esquirol has been loud and eloquent in enforcing 
regard to the feelings, and attention to the real welfare of 
the insane ; and in his private establishment at Ivry, near 
Paris, which I had the gratification of visiting along with 
him in September 1881, he exemplifies almost every prin- 



WHAT ASYLUMS OUGHT TO BE. 221 

ciple upon which an asylum ought to be conducted. The 
asylum is placed in a beautiful and airy situation, with a 
pleasant exposure ; and its general aspect is that of an in- 
habited and well kept villa. Four distinct buildings, of 
ample size and elegant appearance, are conveniently distri- 
buted through a well laid out and ornamented park of twenty- 
five acres, part in garden, part in grass, and part in planta- 
tion, with neat walks bordered with flowers, running in every 
direction ; which, it will be observed, is a very handsome pro- 
vision for thirty or thirty-five patients, to which number he 
restricts himself. For the troublesome or excited patients, 
there are two neat one-story buildings, one for males, and the 
other for females, separate from each other, and far removed 
from those appropriated to the convalescent and tranquil. 
These one-story tenements open upon, and look into spa- 
cious grass plots, surrounded on two sides by high walls, 
along which covered galleries are made for shelter from the 
rain and sun ; so that the height of the walls seems as if 
intended to admit of galleries being made, rather than for 
the purpose of preventing escape. The third side is occu- 
pied by a plain., neat, high railing, like that of Tuilleries 
Garden. To these plots and galleries the patients have ac- 
cess at pleasure ; and most of them prefer coming out at the 
window, from which they can easily step, no restraint being 
visible, and nothing of the prison being apparent. This 
degree of harmless freedom tranquillizes them amazingly. 
Each room (neatly and plainly furnished) has beside it a 
room for a servant, each patient having one, so that ample 
surveillance is exercised. When a little confirmed in tran- 
quillity, they are allowed to go out by a back door to a 
large ornamental walk, shrubbery and garden, with a fine 
view over a lower wall, apparently opening upon the public 
fields, but in reality perfectly retired. The attendants are 
more refined and gentle in their manners, and better edu- 
cated., as well as naturally more humane and intelligent, 



222 WHAT ASYLUMS OUGHT TO BE. 

than the corresponding class of persons in this country. 
Their number, intelligence, and amiable dispositions, are a 
great advantage both to themselves and to the patients. 
Being less exclusively confined to the society of the insane, 
they have not that peculiar expression of eye, and general 
appearance, which our keepers so often acquire, and which 
indicate a state in some degree allied to insanity. Esquirol 
says that his English visitors complain of the difficulty of get- 
ting any but coarse and ignorant men for keepers, and wonder 
how he succeeds ; but the French, of all classes, are natural- 
ly more observant of the kindnesses of ordinary intercourse, 
especially with their inferiors, than we are, and are habitu- 
ally more tolerant of the caprices and weaknesses of others. 
The different classes of society thus stand at all times in a 
more favourable position than with us for acquiring an in- 
terest in each other, and for becoming friends, or, in other 
words, for effecting a cure. The importance of this confi- 
dence was well illustrated by an expression of Esquirol's, in 
speaking of a patient. * At last,' he said, < I succeeded in 
gaining his confidence, and after that,' he added with a sig- 
nificant look, < on va vite a la guerison/ This, of course, 
must be received as a general proposition only, but it shows 
the force of the principle. When tranquillity is secured, the 
patient is removed to another building, and from that to a 
third, each bringing him nearer and nearer to ordinary life, 
till, in a third, convalescents meet, in the character of ladies 
and gentlemen, at meals, music, billiards, reading, &c, along 
with the family of Dr. Metivier, a nephew of Esquirol, who 
resides there with his wife and children. There the patients 
receive their friends, and with them make excursions to the 
environs, or to go to the theatre, — or if from the provinces, 
they go and see the wonders of the capital. They are thus 
gradually prepared to resume their station in society, and 
from being treated throughout with most considerate kind- 
ness, they become attached to the family, and cease to repine 



WHAT ASYLUMS OUGHT TO BE. 223 

at their temporary separation from friends and home. But 
not to dwell too long on this most interesting subject, I shall 
conclude at once by remarking, that it is necessary only to 
see the different appearance and conduct of the patients in a 
well contrived and properly regulated asylum, as contrasted 
with one of an opposite character, to perceive at once how 
influential active moral treatment is in promoting recovery, 
and how necessary it is to devote more attention than hitherto 
to this and the other conditions of health in our treatment 
of the insane."* 

In some parts of America, there appears to be a complete 
realization of all that I have wished to inculcate as necessary 
to place the lunatic in that condition which is most conducive 
to his happiness and recovery. " In respect to the moral 
and intellectual treatment," remark the Visiting Physicians 
of the Retreat at Hartford, " the first business of the physi- 
cian, on the admission of a patient, is to gain his entire 
confidence. With this view he is treated with the greatest 
kindness, however violent his conduct may be — is allowed 
all the liberty which his case admits of, and is made to un- 
derstand, if he is still capable of reflection, that so far from 
having arrived at a madhouse, where he is to be confined, 
he has come to a pleasant and cheerful residence, where all 
kindness and attention will be shown him, and where every 
means will be employed for the recovery of his health. In 
case coercion and confinement become necessary, it is im- 
pressed upon his mind, that this is not done for the purpose 
of punishment, but for his own safetj' and that of the keepers. 
In no case is deception on the patient employed or allowed : 



* The Principles of Physiology applied to the preservation of health, 
and to the improvement of Physical and Mental Education. By An- 
drew Combe, M.D. Fifth Edition, pp. 425—428. 

A very interesting account of this institution has just appeared in 
the New Monthly Magazine. May 1837. 



224 WHAT ASYLUMS OUGHT TO BE. 

on the contrary, the greatest frankness, as well as kindness, 
forms a part of the moral treatment. His case is explained 
to him, and he is made to understand, as far as possible, the 
reasons why the treatment to which he is subjected has be- 
come necessary."* A plan commenced on principles so 
rational and benign, could not fail to effect all that is in the 
power of art : we accordingly find towards the conclusion of 
the Report, that in one year there had been admitted 
twenty-three recent cases, of which twenty-one recovered, a 
number equivalent to 91^ per cent. 

Dr. Burrows gives the following description of a justly 
celebrated asylum at Pirna in Saxony. To some of the ar- 
rangements, however, I entertain strong objections. " This 
lunatic establishment was formerly the castle of Sonnenstein, 
and is situated on an almost perpendicular rock, two hun- 
dred feet above the river Elbe, over which it projects. The 
ascent has now been rendered less abrupt ; and the castle, 
gardens, courts, and out-buildings, have been converted into 
the best lunatic asylum I have seen out of England. The 
number of patients which it contains is about 120, and 
twenty more in the private house of Dr. Pienetz, the head 
physician. We first visited a court-yard, where numbers of 
patients were employed in sawing and chopping wood, others 
drawing water from a deep well, and in fact all were occu- 
pied. The bath-room is of a good size, containing eight 
metal baths, in which the patient may be fixed if necessary. 
There is an excellent apparatus for directing a powerful 
stream of water upon any part of the bath-room. In an ad- 
joining room is the bath of surprise. Here the patient is 
seated in a metal slipper bath, sunk in the ground, the at- 
tendant then comes to a window about fourteen feet above 
the patient, and throws a large bucketfull of water upon the 
head. This is often made use of both as a remedy and as a 

* Hall's Travels in North America, vol. ii. p. 195. 



WHAT ASYLUMS OUGHT TO BE. 225 

punishment, and the patients complain of pain as if the late- 
ral lobes of the cerebrum were split asunder. We next went 
into a large billiard room, to which the patients have con- 
stant access of an evening, especially during winter. The 
evening winter-room is extremely well-fitted up with piano- 
fortes, violins, flutes, three or four backgammon and draft- 
boards, and a very good book-case, which is at all times 
open to the patients. They are allowed to remain here until 
ten o'clock, and music and these games are encouraged as 
much as possible. The patients, in respect to their living, 
are divided into three classes, according to the money that 
is paid for their maintenance. The first class have two small 
rooms for two patients, with one attendant, and they eat their 
meals separate from the others. The second class have also 
two rooms for two patients, with one attendant, but their 
accommodations and fare are not so good. The third class 
dine together, and are six, seven, or eight in one room. 
There is a Protestant church and clergyman in the building, 
and they find that the most noisy patients are quiet during 
divine service. The women's house is quite separate from 
the men's, and is conducted upon the same plan. The gar- 
dens around the building are immense, and are almost 
entirely cultivated by the patients. There are various sum- 
mer amusements in the gardens. Separate from these houses 
is a new house, calculated for sixteen patients and the cler- 
gyman, situated upon a beautiful slope, with an excellent 
garden, and most delightful prospects. This is the conva- 
lescent house, and here the ladies and gentlemen dine with 
the clergyman altogether. They are allowed to take walks 
in the environs, and divert themselves as they please."* 

It is here stated that books are placed within the reach of 
the patients. Dr. Abercrombie recommends a regular course 
of historical reading as a part of the moral discipline in cer- 

* Burrow's Commentaries, pp. 528, 529. 



226 WHAT ASYLUMS OUGHT TO BE: 

tain species of derangement.* I am inclined to think that a 
course of reading of any kind adapted to the powers, previous 
tastes and acquirements regularly pursued, will prove bene- 
ficial. But it is not enough that there should be a well 
selected and easily accessible library in an asylum ; nor that 
books, and maps, and attractive drawings be placed before 
the convalescent patient ; there must be inducements to read 
and examine. And these must be suggested and supplied, 
principally by a study of the dispositions of those whom it 
is our object to interest. We may inflict punishment where 
it is our wish to communicate pleasure, by condemning a 
man who abhors fiction to the perusal of the last new novel ; 
and disgust for every description of reading may be inspired 
by the injudicious choice of such works as offend a prejudice 
or reanimate a delusion. Religious authors are most fre- 
quently resorted to. No error can be more natural or more 
pernicious. It is a noble and beautiful conception that the 
reinvigorated mind should turn in adoration and gratitude 
to the power from whence these new-born energies have 
been derived ; but the effort often proves fatal to the wor- 
shipper by whom it is made. The attempt is akin to that which 
is made by the weak, worn-out, partially restored victim of 
bodily disease to try his strength, that is, to task his nerves 
and muscles, as if they were endowed with their original 
power and activity, and no longer predisposed to lapse into 
that condition from which they have so recently recovered. 
The general practice is alone condemned. For that cases 
every day occur where it is not only safe but expedient, that 
religious impressions should be encouraged by reading as 
well as by preaching, is as evident as that in a country where 
so large a number of persons become insane, either from the 
inherent intensity, or the cultivation of religious feelings, or, 
rendered insane by some other cause, are affected with reli- 

* Inquiries concerning the Intellectual Powers, &c. p. 355. 



WHAT ASYLUMS OUGHT TO BE. 227 

gious mania, it would be eminently hazardous to place works 
on religious subjects within the reach of all those who have 
scarcely yet ceased to bs lunatics. But not only are such 
works objectionable because they are religious, but because, 
in common with every matter which is of great importance, 
and involves our interest and happiness, they are powerfully 
exciting. When the lungs, or heart, or stomach, have been 
diseased, we avoid stimuli, whether they are ardent spirits 
or violent passions, whether they affect the weakened part 
merely, or the whole system. The brain is not exempt from 
the necessity of this precaution. And the instances must be 
extremely rare in which fears or intense desires can be made 
instruments of cure. Indeed, the selection of books, as every 
other arrangement for the behoof of the insane, should be 
regulated by the maxim, dictated as evidently by prudence 
as by philosophy, that the mind should be led back to its 
original and healthy condition, by appealing to those powers, 
the exercise of which is attended with the least possible de- 
gree of excitement. 

The most recent accounts of the Italian asylums which have 
reached this country, are contained in Willis' "Pencillings by 
the Way." This author has been said to eulogize where he ought 
to describe, and to give hyperbole, where statistics are requir- 
ed. There are, it is true, some men of so happy a tempera- 
ment, as to see every thing as through a kaleidoscope. The 
most trivial and hideous objects arrange themselves to such 
minds in forms of beauty and novelty, and the medium by 
means of which the images are created is forgotten. But 
so far as the very interesting picture of the visit to the 
asylum is concerned, this remark does not apply to it. It 
bears truth and fidelity in every line, and although the 
announcement, that in Naples exist " two of the best con- 
ducted asylums in the world," may startle those who are 
accustomed to look upon the distant south as the land of 



228 



WHAT ASYLUMS OUGHT TO BE. 



sunshine and mental darkness : this opinion is fully borne 
out by the facts adduced. When we are informed, that 
"the secret of his, the governor's, whole system, was employ- 
ment and constant kindness," we can readily credit all the 
marvels which ensue. An eccentric old nobleman is the 
wizard who performed these, or, as he is pleased to style 
himself, " the first fool." In moving through a kitchen 
where culinary preparations, extensive enough to occupy 
eight or ten people, are going on, and on encountering 
peaceful and cheerful individuals engaged in painting or 
reading, it is with considerable difficulty that Mr. Willis 
could be convinced that they were all mad. And his 
scepticism must have been still more excited, when he in- 
spected curiously paved courts ornamented with Chinese 
grottoes, trees, artificial rocks, &c, the walls painted as the 
perspective of such a scene, with fountains gushing up in 
the centre, the whole opening upon a large and lovely garden, 
and is told that every thing around is the work of the 
patients. The great charm, the spell which gives the colour- 
ing of happiness to the whole community is, that its members 
are ruled by love, that their sympathies, and not their fears, 
are employed as the ground work of subordination and cure. 
Several exacerbations of fury took place during Mr. Willis' 
visit : they were all, save one, hushed, and tranquillity 
immediately restored by the voice of kind expostulation or 
commiseration. In the stubborn case, which occurred in a 
female, — and I may mention, that the governor has arrived 
at the conclusion, that his most rebellious subjects are 
females, a swing in a hammock was prescribed with the 
desired effect. Had punishment or restraint been substituted, 
the paroxj'sm would in all probability have been exasper- 
ated, and continued until sleep or exhaustion soothed the 
passion or obliterated the insult. This system has been 
suitably rewarded. Two thirds of the patients are stated 



WHAT ASYLUMS OUGHT TO BE. 229 

to be discharged cured. This proposition refers, I presume, 
although the information is not supplied, to the recent cases. 
If it does not, it is the most signal success on record. 

In place of multiplying individual examples of excellence, 
let me conclude by describing the aspect of an asylum as it 
ought to be. Conceive a spacious building resembling the 
palace of a peer, airy, and elevated, and elegant, surrounded 
by extensive and swelling grounds and gardens. The inte- 
rior is fitted up with galleries, and workshops, and music- 
rooms. The sun and the air are allowed to enter at every 
window, the view of the shrubberies and fields, and groups 
of labourers, is unobstructed by shutters or bars ; all is clean, 
quiet, and attractive. The inmates all seem to be actuated 
by the common impulse of enjoyment, all are busy, and de- 
lighted by being so. The house and all around appears a hive 
of industry. When you pass the lodge, it is as if you had en- 
tered the precincts of some vast emporium of manufacture ; 
labour is divided, so that it may be easy and well performed, 
and so apportioned, that it may suit the tastes and powers 
of each labourer. You meet the gardener, the common 
agriculturist, the mower, the weeder, all intent on their 
several occupations, and loud in their merriment. The 
flowers are tended, and trained, and watered by one, the 
humbler task of preparing the vegetables for table, is com- 
mitted to another. Some of the inhabitants act as domestic 
servants, some as artizans, some rise to the rank of overseers. 
The bakehouse, the laundry, the kitchen, are all well sup- 
plied with indefatigable workers. In one part of the edifice 
are companies of straw-plaiters, basket-makers, knitters, 
spinners, among the women; in another, weavers, tailors, 
saddlers, and shoemakers, among the men. For those who 
are ignorant of these gentle crafts, but are strong and steady, 
there are loads to carry, water to draw, wood to cut, and 
for those who are both ignorant and weakly, there is oakum 
to tease and yarn to wind. The curious thing is, that all 

M 



230 WHAT ASYLUMS OUGHT TO BE. 

are anxious to be engaged, toil incessantly, and in general 
without any other recompense than being kept from dis- 
agreeable thoughts and the pains of illness. They literally 
work in order to please themselves, and having once expe- 
rienced the possibility of doing this, and of earning peace, 
self-applause, and the approbation of all around, sound sleep, 
and it may be some small remuneration, a difficulty is found 
in restraining their eagerness, and moderating their exertions. 
There is in this community no compulsion, no chains, no 
whips, no corporal chastisement, simply because these are 
proved to be less effectual means of carrying any point than 
persuasion, emulation, and the desire of obtaining gratifica- 
tion. But there are gradations of employment. You may 
I visit rooms where there are ladies reading, or at the harp or 
piano, or flowering muslin, or engaged in some of those thou- 
sand ornamental productions in which female taste and inge- 
nuity are displayed. You will encounterthem going to church 
or to market, or returning from walking, riding, and driving 
in the country. You will see them ministering at the bed- 
side of some sick companion. Another wing contains those 
gentlemen who can engage in intellectual pursuits, or in the 
amusements and accomplishments of the station to which 
they belong. The billiard-room will, in all probability, 
present an animated scene. Adjoining apartments are used 
as news-rooms, the politicians will be there. You will pass 
those who are fond of reading, drawing, music, scattered 
through handsome suits of rooms, furnished chastely, but 
beautifully, and looking down upon such fair and fertile 
scenes as harmonize with the tranquillity which reigns within, 
and tend to conjure up images of beauty and serenity in the 
mind which are akin to happiness. But these persons have 
pursuits, their time is not wholly occupied in the agreeable 
trifling of conning a debate, or gaining so many points. 
One acts as an amanuensis, another is engaged in landscape 

painting, a third devolves to himself a course of historical 

1 •*> 



WHAT ASYLUMS OUGHT TO BE. 231 

reading, and submits to examination on the subject of his 
studies, a fourth seeks consolation from binding the books 
which he does not read.* In short, all are so busy as to 
overlook, or all are so contented as to forget their misery. 

Such is a faithful picture of what may be seen in many 
institutions, and of what might be seen in all, were asylums 
conducted as they ought to be. 

* To exemplify the various modes of engaging the attention of 
lunatics, it may be mentioned that the manuscripts of these pages were 
transcribed, and the proofs corrected by individuals in the asylum under 
my charge. 



Edinburgh : Balfour & Jack, Printers, Niddry Street. 



INDEX. 



Abercrombie's, Dr., opinion of a course of reading as a means of cure 

in insanity, 225. 
Advantages of permitting those persons intended to take charge of 

lunatics to study insanity in public asylums, 165. 
Age, what, most exposed to insanity, 67 — influence of, on suicidal 

monomania, 86. 
Airing-grounds, 189 — at Ivry, 221. 
Amusements in interior of asylums, 220. 
Animals in airing-grounds, 1 90. 
Appearances, morbid, following insanity, 5. 
Arnold's classification of varieties of insanity, 10. 
Assault upon a lunatic, 163. 

Association of lunatics with superintendent and matron, 202. 
Asylums not open to medical men, 165. 
Asylum, a perfect, 176. 

Author's classification of varieties of insanity, 12. 
Avarice, monomonia of, 39. 



Ball at Salpetriere, 218. 
Baths, 184, 224. 
Benevolence of physician, 178. 
Benevolence and affection, monomania of, 41. 
Bethlem, introduction of religious worship, 208. 
Beauty, external, ought to be regarded in the choice of a site for an 
asylum, 220. 

N 



224 



INDEX. 



Bicetre. employment of lunatics at, 193. 
Billiard-room, 225. 

Board, rate of, as a principle of classification, 199. 
Books, selection of, for lunatics, 226. 
Buildings, separate, in an asylum, 221, 224. 
Burrow's description of Sonnenstein, 224. 

Cages, lunatics confined in, 102. 

Cases, recent, 91. 

Cellars, lunatics confined in, 102. 

Charenton, dramatic representations at, 219 — grounds at, 190. 

Church in asylum at Pirna, 225 — in Dundee, 210. 

Classification, principles of, 199 — according to rate of board, 225 — to 
state of disease, 199 — to degree of education, 201 — form of derange- 
ment, 200 — at one time not attempted, 123. 
.Clothing of lunatics, 189 — supply of, inadequate, 122. 

Coleridge, opinion of, as to the conduct of a physician, 178. 

Combe's description of Ivry, 220. 

Complaints of lunatics disregarded, 158. 

Comforts in the interior of an asylum, 220. 

Confidence of lunatics important to obtain, 222. 

Confinement unnecessary, 116 — resorted to for economy, 119 — substi- 
tuted for coercion, 148. 

Convalescents, number of, provision for, 154. 

Conventual treatment of lunatics, 101. 

Conscientiousness of physician, 179. 

Coercion, unnecessary, 146. 

Copenhagen, dramatic representations at, 219. 

Course of reading as a remedy, 226. 

Courage of physician, 1 80. 

Cruelties perpetrated in asylums, 116, 126. 

Cunning and suspicion, monomania of, 29. 

Cures, proportion of, in insanity, 69. 

Dangerous maniacs, proportions of, 81. 
Dancing, as a remedy, 219. 
Debaucheries, committed in asylums, 127. 
Deception in the treatment of lunatics, 195, 223. 
Derangement, form of, as a principle of classification, 200 — a disease 
of the brain, 4. 



INDEX. 235 

Despondency and suicide, monomania of, 35. 

Diet, 170. 

Difficulty of treating diseases of insane, 74. 

Disease, stage of, as a principle of classification, 199 — aggravation of, 

by brutality of keepers, 162. 
Diseases most prevalent among insane, 76. 
Dormitories, 185 — should be fire-proof, 187. 
Dramatic representations, 219. 
Dairy's asylum, Glasgow, 187. 
Dundee asylum, introduction of worship at, 211. 

Education, amount of, as a principle of classification, 201 — influence 

of, on suicidal mania, 85. 
Egypt affords an early example of the rational treatment of insanity, 141. 
Employment of patients, 228. 
Epileptic patients, proportion of, 78. 
Errors of present system of treatment, 140, 144. 
Esquirol employs the sense of honour as a means of moral treatment, 

203 — his opinion as to the employment of coercion, 1 48. 
Exaggerations of the evils of the old system of treatment, 136. 
Excitement of terror as a remedy, 125. 
Exhibition of lunatics to public, 119. 
Exclusion of patients from church, 173. 

Extremities of patients destroyed by cold, gangrene, rats, &c, 120. 
Evils of confining lunatics among lunatics, 152. 

Fallacy of supposing lunatics to be insensible to cold, 144. 

Fatuity, 14 — partial or complete, 16. 

Fatuous maniacs, proportion of, 79. 

Favoritism, evils of, 204. 

Fear, monomania of, 27. 

Females chiefly exposed to insanity, 68. 

Ferrus of Bicetre, recommends labour, 1 93. 

Fire-proof, parts of an asylum ought to be, 77. 

Fonthill asylum, abuses in, 129. 

Food, inadequate supply of, 121. 

Forcing, 105 — injuries from, 105. 

Fox's, Dr. establishment, 185 — opinion as to religious worship on 

Sunday, 209 — as to harsh treatment, 172. 
Friends of lunatics, exclusion of, 167— estrangement of, 168. 



236 INDEX. 

Fund for support of lunatics subsequent to their discharge, 198. 
Furious maniacs, proportions of, 77. 

Galleries, 186. 

Gaols, confined in, 102~evils of such an arrangement, 104. 

Gentlemen less furious than paupers, 118. 

Gheel, village of, long celebrated for the cure of the insane, 142. 

Hammock, swinging in, as a remedy, 228. 
Hartford, United States, asylum at, 223. 
Heating, provisions for, 1 88. 
Heinroth's classification of varieties of insanity, 1 1 . 
Homicidal or destructive monomania, 20. 
Honour, appeal to, in moral treatment, 202. 
Hospitals, lunatics confined in, 107. 
Houses for friends of patients, 222. 

Idiocy, 12. 

Improvements in present system, 134. 

Imagination, monomania of, 38. 

Indulgence of patients, 170. 

Industry of lunatics, 229. 

Incapability of perceiving the relations of ideas, 42— the relations of 
external objects, 44 — the qualities of external objects, 46. 

Incompatibilities of character which should be attended to in classify- 
ing lunatics, 1 55. 

Infant school, an asylum should resemble, 193. 

Insanity, definition of, 7 — an adjunct to civilization, 52 — increase of, 
54 — ranks of life chiefly affected by, 59 — cure of by an argument, 
214 — by a jest, 214 — example of such cure, 214 — cure of by a 
pretended operation, 215 — instantaneous cure of, 216. 

Intellectual qualifications of physician, 180. 

Intercourse of sane with insane, 153. 

Interests of superintendents of public and private asylums, 174. 

Isolation, complete, 90. 

Italy, asylums in, 227. 

jvry, Esquirol's establishment at, 220 — separate houses at, 185. 

Keepers, duties and responsibility of, 160 — properly educated in 
France, 164 — qualifications of, 221 — one for each patient, 221 — 



INDEX. 237 

numbers of, 222 — proportions of to patients, 147 — ought to be 
frequently changed, 205 — disadvantages of such a step, 206 — care 
of lunatics confided entirely to, 124. 
Kitchen, patients employed in, 228. 

Labour, 229 — division of, 229 — as a remedy, 92 — ought to have an 

object, 192. 
Language, profane and obscene, heard in asylums, 161. 
Legislative interference, 173. 
Liberation of prisoners from Bastile, 137 — of patients from cells of 

Bicetre, 137. 
Liberty, what is meant by, in an asylum, 204. 
Longevity, is it increased by insanity ? 73. 
Lucett's method of treatment, 216. 
Lucid intervals, 88. 
Lunatics, proportion of, that may be employed, 93 — employed as 

keepers, advantages and evils of, 164-201 — supposed to be callous 

to insults, 159. 

Males least subject to insanity, 68. 

Mania, 47 — active or passive, 48. 

Marriage, influence of, on insanity, 67. 

Meals> solitary, 171. 

Medical treatment at one time supposed to be fruitless, 123. 

Mental powers, division of, 3. 

Mental manifestation, connexion of with brain, 3. 

Menteith, Mr. A. E., speech of, at meeting of Prison Discipline So- 
ciety, 103. 

Metivier, resident physician at Ivry, 222. 

Milanese physician cured insanity by chaining in a well, 216. 

Minds of patients corrupted by keepers, 161. 

Monomania, definition of, 17. 

Montrose, introduction of worship at, 211. 

Moral treatment, 156— at one time not attempted, 123— fallacies as 
to, 214 — quackeries in, 216. 

Mortality, rate of among insane, 75. 

Mound in centre of airing-grounds, 189. 

Muffling, 105. 

Music -rooms, 229. 



238 



INDEX. 



Mystery foolish and hurtful, 216. 

Nantes, asylum at, 112* 

Negligence in some small asylums, 121. 

Night-keeper, 186 — advantages of, 186. 

Night visits of commissioners, 157 — objections to, 157. 

Number of lunatics in England, 51 — in Scotland, 51. 

Occupation, 177 — should be real, 230 — for higher classes of patients, 

230. 
Oppression, acts of, in asylums, 145. 
Oubliettes, asylums served as such, 1 16- 

Paralytic maniacs, proportion of, 78 — provisions for, in the construc- 
tion of asylums, 183. 

Pariset sanctions dancing, 219. 

.Park at Ivry, 221. 

Patients, noisy, placed in separate houses, 185 — proportion of, 80. 

Patients irritated for amusement of visitors, 162. 

Physician, qualifications of, 178- 

Pinel's exposure of the " tact" of the English physicians, 218 — intro- 
duction of a system of treatment founded on humanity, 138. 

Pirna in Saxony, asylum at, 224. 

Prejudices as to the necessity for harsh treatment, 172 — as to the ef- 
fects of medicine, 178. 

Prevalence of insanity under free or despotic governments, 62 — in 
America, 64 — causes of, 64. 

Pride, monomania of, 23. 

Professions particularly affected by insanity, 56. 

Propensities, definition of, 3. 

Proportion of sane to insane population, 52. 

Punishment, corporeal, generally abandoned, 145 — when admissi- 
ble, 203. 

Recoveries, proportion of, 224, 228. 
Reflective and perceptive powers, definition of, 3. 
Religion and superstition, monomania of, 31. 
Religious feelings, cultivation of, 213. 

Religious worship in asylums, error as to, 206 — discrimination of cases 
fitted for, 207 — should be regulated by idiosyncracies of patients, 



INDEX. 239 

207 — classes of patients to be admitted, 207 — classes to be excluded 
from, 208 — indispensable in some forms of madness, 210 — mode in 
which it should be performed, 210 — effects of, 210. 

Reluctance of friends to confine insane, 91. 

Remuneration, in money, for labour of lunatics, 197. 

Rich, provision for in asylums, 169. 

Rickett's, Mr., opinion as to religious worship, 210, 212. 

Rouen, grounds at, 1 90. 

Sacrament, patients admitted to, 213 — objections to such a step, 213. 

Salpetriere, ball at, 218. 

Samaritan Societies, 199. 

Satyriasis, 18. 

Season, influence of, on mortality of insane, 70. 

Seclusion of sane in asylums, 1 13. 

Sense of injury sometimes preternaturally acute, 1G0. 

Sentiments, definitions of, 3. 

Services, religious, private, 208 — should be regulated by idiosyncracies 
of patients, 207 ; — sex, no distinction of, in some asylums, 128. 

Sexes, provisions for different proportions of, 184. 

Site of an asylum, 181 — external beauty of, 220, 229 — effects of on 
health, 182. 

Sonnenstein, grounds at, 190 — religious worship at, 213. 

St. Vincent de Paul, efforts of, 100. 

Students admitted at Salpetriere, 166. 

Suicidal maniacs, proportions of, 82. 

Suicides in France, 84. 

Sunday should be selected as the day for religious worship in an asy- 
lum, 209 — reasons for, and advantages of this choice, 209. 

Superstition blended with rational treatment in Egypt and at Gheel, 
141. 

System pursued previous to 1815, 99. 

Tasks appointed for lunatics, 198. 
Tenements of one story, 221. 
Terraces at Cbarenton, 192. 
Terror, excitement of as a remedy, 125. 
Tom o' Bedlams, origin of, 101. 
Travelling, substitute for isolation, 178. 
Trees in airing grounds, 189. "^ 



J - 

240 INDEX, 

Vanity, monomania of, 26. 

Varieties of insanity, arrangement of, 10. 

Venice, asylum at, 1 1 2. 

Visit to an asylum as it ought to be, 228. 

Visit to asylums as they were, 132. 

Voisin and Falret's establishment, 219. 

Wages for labour of lunatics, 195 — advantage of, 196 — withheld in 

some institutions, 195. 
Wages of keepers should be increased, 166. 
Warburton's establishment, 185. 
Water-closets, 185. 
Willis's Pencillings by the Way, 227. 
Workhouses, lunatics confined in, 107, 110. 
Working-houses for lunatics, 198. 
Workshops, 229. 
Worship, religious, errors as to, 206 — discrimination of cases fitted 

for, 207. 

York asylum, abuses in, 130. 






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